Hiatal hernia repair in the era of robotic surgery: lessons learned from a single-center experience

Aim: Robotic-assisted surgery has been successfully introduced in hiatal hernia repair; however, clear advantages over laparoscopy remain limited, with small series and contradictory results. This study aims to evaluate the outcomes of robotic hiatal hernia repair in non-selected patients. Methods: All patients presenting with symptomatic hiatal hernia were included. The DaVinci® robotic platform was used, and a strict standardized operative technique was performed. Preoperative and postoperative data were prospectively collected and retrospectively analyzed. Results: A total of 103 consecutive, unselected patients underwent surgery. Median total operating time was 72 min [range 46-168 min]. The 30-day complication rate was 12% (12/103). After a median follow-up of 29 months [range 1-64 months], the late complication rate was 5% and the recurrence rate was 5%. Conclusion: Robotic surgery is a valuable option for hiatal hernia repair, especially in difficult cases or emergency operations. Whether this translates to better long-term outcomes needs to be further investigated in series with longer follow-up.