Robotic-assisted hiatal hernia repairs with and without magnetic sphincter augmentation (MSA): short- and long-term patient-centered outcomes in a single academic center.

Introduction: Hiatal Hernia (HH) repairs are commonly performed using a laparoscopic (L) approach. Recently, the robotic-assisted (RA) approach was introduced. The objective of the study is to describe our experience and analyze patient-centered clinical outcomes of RA-HH repairs with and without MSA (Magnetic Sphincter Augmentation).

Methods: Patients who underwent RA-HH repair with or without MSA between April 2018 and February 2023 were included. The data were summarized using mean and standard deviation for all continuous variables. Frequency and percent were used for categorical data. Postoperative endoscopy and/or barium swallow were done on all patients. Postoperative clinical follow-up occurred at 2 weeks, 3,6,12, and 24 months. At 6 months, the Gastroesophageal Reflux Disease Health-Related Quality-of-Life (GERD-HRQL) scale was used to assess quality of life and symptom severity. The data were analyzed for both MSA and non-MSA patients and reported at 2 years. All data management and analysis were conducted using Stata V.18.

Results: Overall, the study included 295 patients. 30-day readmission and ED visit rates were 7.51% and 14.92%, respectively. In-hospital postoperative complication rate was 10.85%. We had no 30-day mortality. Conversion to open was 0.34%. Hospital length of stay was 0-1 day in 82.03% of cases. GERD-HRQL score decreased from 8.78 preoperatively to 1.34 at 6 months with 86.1% of patients reporting a score of 0. Our follow-up rate at year 2 from the index procedure was 74% ( 217 patients out of 295). Hernia recurrence rate at 24 months was 3.93%. PPI use at 2 years was 38.71%. MSA group had more post-op globus at 24 months (5.13% vs 1.12%) but similar rates of post-op heartburn and PPI use.

Conclusion: RA-HH at our center appears to be safe and feasible with low recurrence rates at 24 months. MSA had similar rates of PPI use but more post-op globus compared to the non-MSA group at 2 years.