Early robotic experience with paraesophageal hernia repair and Nissen fundoplication: short-term outcomes

The applications of robot-assisted surgery continue to expand. Several recent studies have examined the use of robotic Nissen fundoplication (RF) for treatment of gastroesophageal reflux disease (GERD). Our experience with RF has led us to introduce this technology for the treatment of paraesophageal hernias (PEH). There is little information about the short-term outcomes of patients undergoing robotic paraesophageal hernia repair (RPEH). The goal of our study was to summarize the short-term outcomes of patients who underwent either RF or RPEH. We conducted a retrospective review of all patients who underwent RPEH and RF by a single surgeon between June, 2005 and August, 2006. Data collected included age, gender, body mass index (BMI), co-morbidities and prior operations, and ASA class. Outcomes included operating times, length of stay, pain medication use, and perioperative complications. We performed a comparison of the two groups using the Mann–Whitney U test for statistical significance. Seven patients underwent RPEH, and 19 patients underwent RF alone. Four patients were excluded from the RF group. Patients in the RPEH group had a significantly higher BMI (33 vs. 26 kg/m², P = 0.007) and significantly more comorbidities (6 vs. 4, P = 0.004). There was no calculated statistical difference between the two groups in regards to age, ASA class, operating times, length of stay, or complications. Patients undergoing RPEH have similar short-term outcomes when compared to patients undergoing RF. The skills necessary for RF can be easily applied to RPEH, despite technical differences between the two operations. Similar morbidity can be anticipated between the two groups. Presented at the Minimally Invasive Robotic Association 2nd International Congress, January 2007, New York, NY, USA. Dr Dunnican has an unrelated research grant from the Natural Orifice Surgery Consortium for Assessment and Research.