PMID- 31811451 OWN - NLM STAT- MEDLINE DCOM- 20210528 LR - 20210528 IS - 1432-2218 (Electronic) IS - 0930-2794 (Linking) VI - 34 IP - 6 DP - 2020 Jun TI - Safety of robotic assisted laparoscopic recurrent paraesophageal hernia repair: insights from a large single institution experience. PG - 2560-2566 LID - 10.1007/s00464-019-07291-y [doi] AB - BACKGROUND: Laparoscopic repair of recurrent as opposed to primary paraesophageal hernias (PEHs) are historically associated with increased peri-operative complication rates, worsened outcomes, and increased conversion rates. The robotic platform may aid surgeons in these complex revision procedures. The aim of this study was to compare the outcomes of patients undergoing robotic assisted laparoscopic (RAL) repair of recurrent as opposed to primary PEHs. METHODS: Patients undergoing RAL primary and recurrent PEH repairs from 2009 to 2017 at a single institution were reviewed. Demographics, use of mesh, estimated blood loss, intra-operative complications, conversion rates, operative time, rates of esophageal/gastric injury, hospital length of stay, re-admission/re-operation rates, recurrence, dysphagia, gas bloat, and pre- and post-operative proton pump inhibitor (PPI) use were analyzed. Analysis was accomplished using Chi-square test/Fischer's exact test for categorical variables and the Mann-Whitney U test for continuous variables. RESULTS: There were 298 patients who underwent RAL PEH repairs (247 primary, 51 recurrent). They were followed for a median (interquartile range) of 120 (44, 470) days. There were no significant differences in baseline demographics between groups. Patients in the recurrent PEH group had longer operative times, increased use of mesh, and increased length of hospital stay. They were also less likely to undergo fundoplication. There were no significant differences in estimated blood loss, incidence of intra-operative complications, re-admission rates, incidence of post-operative dysphagia and gas bloat, and incidence of post-operative PPI use. There were no conversions to open operative intervention or gastric/esophageal injury/leaks. CONCLUSIONS: Although repair of recurrent PEHs are historically associated with worse outcomes, in this series, RAL recurrent PEH repairs have similar peri-operative and post-operative outcomes as compared to primary PEH repairs. Whether this is secondary to the potential advantages afforded by the robotic platform deserves further study. FAU - Sowards, Kendell J AU - Sowards KJ AD - Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA. FAU - Holton, Nicholas F AU - Holton NF AD - Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA. FAU - Elliott, Ekatarina G AU - Elliott EG AD - Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA. FAU - Hall, John AU - Hall J AD - Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA. FAU - Bajwa, Kulvinder S AU - Bajwa KS AD - Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA. FAU - Snyder, Brad E AU - Snyder BE AD - Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA. FAU - Wilson, Todd D AU - Wilson TD AD - Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA. FAU - Mehta, Sheilendra S AU - Mehta SS AD - Texas Laparoscopic Consultants, Houston, TX, USA. FAU - Walker, Peter A AU - Walker PA AD - Health First Medical Group, Rockledge, FL, USA. FAU - Chandwani, Kavita D AU - Chandwani KD AD - Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA. FAU - Klein, Connie L AU - Klein CL AD - Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA. FAU - Rivera, Angielyn R AU - Rivera AR AD - Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA. FAU - Wilson, Erik B AU - Wilson EB AD - Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA. FAU - Shah, Shinil K AU - Shah SK AD - Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA. shinil.k.shah@uth.tmc.edu. AD - Michael E. DeBakey Institute for Comparative Cardiovascular Science and Biomedical Devices, Texas A&M University, College Station, TX, USA. shinil.k.shah@uth.tmc.edu. FAU - Felinski, Melissa M AU - Felinski MM AD - Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA. LA - eng PT - Journal Article DEP - 20191206 PL - Germany TA - Surg Endosc JT - Surgical endoscopy JID - 8806653 SB - IM MH - Female MH - Hernia, Hiatal/*surgery MH - Herniorrhaphy/*methods MH - Humans MH - Male MH - Middle Aged MH - Recurrence MH - Retrospective Studies MH - Robotic Surgical Procedures/*methods OTO - NOTNLM OT - Fundoplication OT - Hiatal hernia OT - Laparoscopy OT - Paraesophageal hernia OT - Robotic surgery EDAT- 2019/12/08 06:00 MHDA- 2021/05/29 06:00 CRDT- 2019/12/08 06:00 PHST- 2018/04/14 00:00 [received] PHST- 2019/11/28 00:00 [accepted] PHST- 2019/12/08 06:00 [pubmed] PHST- 2021/05/29 06:00 [medline] PHST- 2019/12/08 06:00 [entrez] AID - 10.1007/s00464-019-07291-y [pii] AID - 10.1007/s00464-019-07291-y [doi] PST - ppublish SO - Surg Endosc. 2020 Jun;34(6):2560-2566. doi: 10.1007/s00464-019-07291-y. Epub 2019 Dec 6.