Contemporary operative and clinical outcomes of primary robotic repair of paraesophageal hernia at a high-volume center

Abstract Background Role of robotic approach in hiatal and paraesophageal hernia (HH/PEH) repair is evolving. This study aims to review clinical outcomes of a robotic-assisted PEH repair performed in a high volume center. We also examined symptom outcomes of robotic PEH repair and impact of recurrence on symptoms. In this study, we focused on PEH, with the exception of HH. Methods In a retrospective review of 275 consecutive patients undergoing robotic PEH repair between 2018 and 2023, we evaluated patient demographics, operative techniques, hernia characteristics, and impact on the top three symptom amelioration. Clinical outcomes including length of stay (LOS), radiographic recurrence, need for revisional intervention, on post-operative symptom resolution were studied. Results 275 patients underwent robotic PEH repair with average LOS of 1.4 days and readmission rate of 1.8%. Radiographic recurrence of 12.7% led to reintervention in 1.8% of this cohort. Comparing the recurrence and non-recurrence, there were significant differences in age, hernia size, fundoplication type and postoperative Clavien-dindo classification ( p < 0.05). However, in the multivariate analysis, neither age nor hernia size—both considered preoperative risk factors—emerged as significant independent factors. Majority of patients showed symptom improvement, however less for “Dysphagia” than “Regurgitation”(p < 0.05). Conclusion Robotic PEH repair can be performed safely with excellent clinical outcomes and consistent amelioration of preoperative symptomatology. Robotic approach can be considered mainstay surgical therapy for PEH of all sizes while continued assessment in the future.