A retrospective comparative study comparing laparoscopic and robotic hiatal hernia repair: surgical outcomes, recurrence rate, and postoperative morbidity

Hiatal hernia repair is commonly performed using minimally invasive surgical techniques, including laparoscopic and robotic approaches. Although robotic surgery offers enhanced visualization and improved instrument dexterity, controversy remains regarding its superiority over conventional laparoscopy in terms of recurrence, postoperative morbidity, and overall surgical outcomes. This study aimed to compare laparoscopic and robotic hiatal hernia repair regarding surgical outcomes, recurrence rates, and postoperative morbidity. This retrospective comparative study was conducted at Hamad Medical Corporation during the period from January 2019 to September 2025. A total of 126 patients who underwent hiatal hernia repair were included and categorized into laparoscopic and robotic surgery groups according to the operative approach. Data were retrospectively collected from electronic medical records, operative reports, imaging findings, and follow-up documentation. Demographic characteristics, operative details, postoperative complications, recurrence, readmission, reoperation, and mortality outcomes were analyzed. Comparative analysis between both groups was performed using appropriate statistical tests, while multivariable logistic regression analysis was conducted to identify predictors of recurrence and mortality. Statistical significance was considered at p < 0.05. A total of 126 patients underwent hiatal hernia repair, including 73 (57.9%) laparoscopic and 51 (40.5%) robotic procedures. The robotic group had a significantly longer mean operative time than the laparoscopic group (4.78 ± 1.25 vs. 3.84 ± 1.36 h, p < 0.001), but a significantly shorter mean hospital stay (5.57 ± 1.64 vs. 7.27 ± 3.08 days, p < 0.001). Postoperative complications differed significantly between groups, with fewer complications observed in the robotic group (p = 0.029). Thirty-day readmission (3.2%) and reoperation (0.8%) were uncommon, with no 30-day postoperative mortality. Overall recurrence occurred in 19.8% of patients and was significantly higher in the laparoscopic group than in the robotic group (27.4% vs. 9.8%, p = 0.016). In multivariable analysis, higher ASA score, smoking, and longer operative duration were independently associated with increased recurrence risk, whereas Nissen fundoplication and Phasix mesh reinforcement were associated with lower recurrence odds. Both laparoscopic and robotic hiatal hernia repair demonstrated favorable postoperative outcomes with low rates of major morbidity and mortality. Robotic repair was associated with longer operative duration but showed trends toward lower recurrence and postoperative complication rates. Larger prospective studies are recommended to further evaluate the long-term comparative effectiveness of both surgical approaches.