Our Summary

This research paper is a comparison study between two surgical procedures used to repair hiatal hernias - laparoscopic and robotic-assisted techniques. The study used a large database of hospitalizations from 2010 to 2019, during which time approximately 517,864 procedures were carried out.

The researchers discovered that robotic-assisted surgeries, which represented 11.3% of the total number, had a higher rate of complications compared to laparoscopic procedures. Even after adjusting for different patient and hospital factors, the complication rate was still higher. In addition, patients who underwent robotic-assisted surgery had a greater likelihood of being readmitted to hospital within 30 or 90 days after surgery.

On a more positive note, the study found no significant difference between the two procedures when it came to patient deaths during hospital stays or how long patients needed to stay in hospital. However, the robotic-assisted surgeries were generally more expensive.

The research did find that as doctors and hospitals gained more experience with robotic surgeries, the rates of complications and readmissions tended to decrease. This suggests that as this technique continues to be used and improved, its risks may decrease.

FAQs

  1. What were the two surgical procedures compared in this study for hiatal hernia repair?
  2. How did the complication rates of robotic-assisted surgeries compare to laparoscopic procedures?
  3. Did the study find any correlation between the experience level of doctors and hospitals with robotic surgeries and the rates of complications and readmissions?

Doctor’s Tip

A helpful tip a doctor might give a patient about hiatal hernia repair is to discuss with them the pros and cons of both laparoscopic and robotic-assisted surgical techniques. It’s important for patients to be informed about the potential risks and benefits of each procedure so they can make an educated decision about their treatment. Additionally, patients should inquire about the experience level of their surgeon with the chosen technique, as the study suggests that outcomes may improve as surgeons gain more experience with robotic-assisted surgeries. Lastly, patients should be proactive in their recovery by following post-operative care instructions closely and attending all follow-up appointments to ensure a successful outcome.

Suitable For

Patients who are typically recommended for hiatal hernia repair include those who experience symptoms such as heartburn, regurgitation, chest pain, difficulty swallowing, and abdominal pain. Hiatal hernias can be classified as sliding or paraesophageal, with paraesophageal hernias being more likely to cause symptoms and complications. Patients with larger hiatal hernias, recurrent hernias, or complications such as Barrett’s esophagus or strictures may also be recommended for surgical repair.

In general, patients who do not respond well to conservative treatments such as medications or lifestyle changes may be candidates for surgery. Additionally, patients who experience complications such as gastroesophageal reflux disease (GERD), esophagitis, or respiratory issues related to their hiatal hernia may also be recommended for surgery.

Ultimately, the decision to undergo hiatal hernia repair surgery is made on a case-by-case basis, taking into consideration the individual patient’s symptoms, medical history, and overall health. It is important for patients to discuss their options with their healthcare provider to determine the best course of treatment for their specific situation.

Timeline

Before hiatal hernia repair:

  1. Patient experiences symptoms such as heartburn, chest pain, difficulty swallowing, and acid reflux.
  2. Patient undergoes diagnostic tests such as endoscopy, barium swallow, and pH monitoring to confirm the presence of a hiatal hernia.
  3. Patient discusses treatment options with their healthcare provider, including lifestyle changes, medications, and surgical repair.
  4. Patient undergoes pre-operative evaluation to assess their overall health and fitness for surgery.

After hiatal hernia repair:

  1. Patient undergoes either laparoscopic or robotic-assisted surgery to repair the hiatal hernia.
  2. Patient is monitored in the hospital for complications and recovery from surgery.
  3. Patient is discharged from the hospital and instructed on post-operative care, including diet and activity restrictions.
  4. Patient follows up with their healthcare provider for post-operative visits to monitor their recovery and address any issues.
  5. Patient experiences improvement in symptoms such as heartburn and acid reflux over time as the hiatal hernia is repaired.

What to Ask Your Doctor

Some questions a patient should ask their doctor about hiatal hernia repair include:

  1. What are the potential risks and complications associated with both laparoscopic and robotic-assisted surgery for hiatal hernia repair?
  2. Is one surgical technique preferred over the other based on my specific medical history and condition?
  3. How experienced are you and the hospital with performing robotic-assisted surgeries for hiatal hernia repair?
  4. What is the expected recovery time and post-operative care for each surgical technique?
  5. Are there any long-term differences in outcomes or quality of life between laparoscopic and robotic-assisted surgery for hiatal hernia repair?
  6. What factors should I consider when making a decision between laparoscopic and robotic-assisted surgery for hiatal hernia repair?
  7. Are there any alternative treatment options for hiatal hernia repair that I should be aware of?

Reference

Authors: Klock JA, Walters RW, Nandipati KC. Journal: J Gastrointest Surg. 2023 Mar;27(3):489-497. doi: 10.1007/s11605-022-05548-x. Epub 2022 Dec 12. PMID: 36508133