Experience of robot-assisted and laparoscopic fundoplications for treatment of hiatal hernias complicated by gastroesophageal reflux disease

Background. In the last 30 years, minimally invasive interventions have served as the priority treatment for hiatal hernias complicated by gastroesophageal reflux disease. Laparoscopic fundoplication is considered the “gold standard” of anti-reflux therapy, but the number of robotassisted surgeries has been growing since 2018, which necessitates comparison of these approaches.

Aim. Comparative evaluation of efficacy and safety of laparoscopic and robot-assisted accesses during fundoplications to treat hiatal hernias.

Materials and methods. Retrospective single-center study of treatment results of 270 patients who underwent surgery due to hiatal hernia at the S.P. Botkin Moscow Multidisciplinary Scientific and Clinical Center of the Moscow Healthcare Department between 2018 and 2025 was performed. Type I hernia per the SAGES (Society of American Gastrointestinal and Endoscopic Surgeons) classification was observed in 7 (2.6 %) patients, type II – in 25 (9.3 %), type III – in 141 (52.2 %), type IV – in 97 (35.9 %). Laparoscopic fundoplication was performed in 109 (40.4 %) cases, robotassisted – in 161 (59.6 %).

Results. Among 32 patients with type I and II hernias, laparoscopic surgery was performed in 14 (5.2 %), robot-assisted fundoplication – in 18 (6.7 %); among 141 patients with type III hernias – in 63 (23.3 %) and 78 (28.9 %), respectively. In the patient group with type IV hernias, laparoscopic access was used in 32 (11.9 %) cases, robot-assisted – in 67 (24 %). Nissen fundoplication was performed in 259 (95.9 %) patients, Chernousov fundoplication – in 11 (4.1 %) cases. Mean operative time for laparoscopic access was 155 min, for robot-assisted access – 122 min. Grade I–II postoperative complications per the Clavien–Dindo classification were reported in the laparoscopic fundoplication group in 8 (7.3 %) cases, in the robot-assisted group – in 7 (4.3 %). Hiatal hernia recurrence was observed in 5 (4.6 %) cases after laparoscopic fundoplication and in 3 (1.8 %) cases after robotassisted surgery.

Conclusion. While the identified differences were not statistically significant, robot-assisted surgeries for larger hernias have clinical and intraoperative benefits and therefore should be preferred in cases with high risk of postoperative complications.

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