Postoperative quality of life after minimally invasive repair of giant hiatal hernias

BACKGROUND: Type III and IV hiatal hernias require surgical repair to improve symptoms and prevent complications. Long-term patient-reported outcomes following minimally invasive repair, particularly with robotic-assisted techniques, remain incompletely described. METHODS: This single-center retrospective cohort study evaluated consecutive patients who underwent elective hiatoplasty for type III or IV hiatal hernia between 2014 and 2024. Quality of life (QoL) was assessed using validated scores (GERD-HRQL, DeMeester symptom score) and a 5-point Likert satisfaction scale. The primary outcome of interest was postoperative QoL. Secondary outcomes included complications, recurrence, and associations with surgical technique (robotic vs. laparoscopic), mesh use, and fundoplication. RESULTS: Eighty patients were selected from 152 treated during the study period. The cohort comprised 71.3% robotic-assisted and 22.5% laparoscopic procedures (6.2% converted). QoL was assessed at a median of 30 months' follow-up. Postoperative median DeMeester symptom score was 1.0 (IQR 0.0-2.0), while median GERD-HRQL was 4.0 (IQR 0.0-8.0). The median satisfaction using the Likert scale was 5.0 (IQR 4.0-5.0). Major complications (Clavien-Dindo ≥ III) occurred in 5.0% of patients, with a 30-day readmission rate of 1.3%. Recurrence was documented in 21.2% (7 out of 33 patients with complete radiological follow-up data), with symptomatic recurrence in 6.1%. Higher BMI and symptomatic recurrence were significantly associated with lower quality-of-life scores (p < 0.05). No significant differences in postoperative QoL, complications, or recurrence were observed between robotic and laparoscopic approaches, with or without mesh reinforcement or fundoplication (p > 0.05). CONCLUSION: Minimally invasive hiatoplasty for type III and IV hiatal hernias achieves excellent long-term quality of life and high patient satisfaction independent of surgical approach, mesh use, or fundoplication. Preoperative BMI optimization, may enhance postoperative outcomes.