Clinical efficacy of robot‑assisted versus laparoscopic hiatal hernia repair combined with Nissen fundoplication

Objective To investigate the clinical efficacy of robot‑assisted versus laparoscopic hiatal hernia repair combined with Nissen fundoplication.

Methods The retrospective cohort study was conducted. The clinical data of 281 patients with hiatal hernia who were admitted to People′s Hospital of Xinjiang Uygur Autonomous Region from January 2018 to December 2024 were collected. There were 140 males and 141 females, aged (60±11) years. Among the 281 patients, 133 cases undergoing robot‑assisted hiatal hernia repair combined with Nissen fundoplication were allocated into robotic group and 148 cases undergoing laparoscopic hiatal hernia repair combined with Nissen fundoplication were allocated into laparoscopic group. Observation indicators: operation time, eso-phageal hiatus transverse diameter, volume of intraoperative blood loss, time to postoperative first flatus, duration of postoperative hospital stay, total hospitalization cost, gastroesophageal reflux disease questionnaire (GERD‑Q) score at postoperative month 3. Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test, com-parison of measurement data with skewed distribution between groups was conducted using the Mann-Whitney U test. Comparison of count data between groups was conducted using the chi-square test.

Results The operation time, esophageal hiatus transverse diameter, volume of intraoperative blood loss, time to postoperative first flatus, duration of postoperative hospital stay, total hospitaliza-tion cost, GERD‑Q score at postoperative month 3 were 121(120,180) minutes, 2.2(1.5,3.4) cm, 20(10,50) mL, 24(12,36) hours, 4(3,6) days, (6.8±1.0)×10⁴ yuan, 2.1±1.0 for the robotic group, and 120(120,180) minutes, 2.4(1.6,3.7) cm, 30(20,50) mL, 36(24,48) hours, 5(4,7) days, (4.4±0.9)×10⁴ yuan, 2.2±1.1 for the laparoscopic group. There were significant differences in the volume of intraopera-tive blood loss, time to postoperative first flatus, duration of postoperative hospital stay, total hospita-lization cost between the two groups (Z=-5.616, -5.872, -5.590, t=21.050, P<0.05), while there was no significant difference in operation time, esophageal hiatus transverse diameter, or GERD‑Q score at postoperative month 3 (Z=-1.218, -1.213, t=0.682, P>0.05).

Conclusions Robot‑assisted and laparoscopic hiatal hernia repair combined with Nissen fundoplication are safe and feasible. Compared to the laparoscopic surgery, robot‑assisted surgery not only reduces volume of intraoperative blood loss and accelerates postoperative recovery of gastrointestinal function, but also shortens postopera-tive hospital stay, although the total hospitalization cost is higher.