Robotic paraesophageal hernia repair

Introduction

Hiatal hernias are a common condition that can be classified into four anatomical types ( Fig. 21.1 ). Type I or sliding hernias comprise over 95% of all hiatal hernias. Paraesophageal hernias (PEH) include types II-IV, which are defined by herniation of either the fundus of the stomach (Types II and III) or herniation of another organ entirely (Type IV). Approximately 90% of PEHs are type III, in which the gastroesophageal junction is herniated with the fundus of the stomach into the mediastinum.

Laparoscopic surgery is the mainstay of surgical treatments. However, numerous reports have suggested that only surgeons with substantial experience in foregut and minimally invasive surgery should attempt laparoscopic repair of PEH. ^, Although robotic surgery is a proliferating technology in general surgery, there is a paucity of data concerning the benefits of robotics for the treatment of PEH. Herein we describe our robot-assisted approach to PEH repair and the value of its addition to our surgical armamentarium.

Indications

Indications for operative repair of PEHs have undergone a significant transformation over the past 40 years. Currently, all patients with PEHs who are symptomatic, and especially those with obstructive symptoms, should be recommended an elective repair.

Patient preparation