A standardized robot-assisted technique for giant paraesophageal hernia repair - the relationship between surgical details and low recurrence rate in long-term follow-up

Sep 30, 2026

Upload by Asher

Giant hiatal hernia (GHH) involves 30–50% or more of the stomach migrating into the chest and is associated with challenging laparoscopic repair and higher recurrence. This study evaluates whether a standardized robot-assisted repair (RAR) can improve outcomes by linking specific surgical details to durability. Using a multicentric prospective database from 2011–2023, 47 consecutive patients underwent a 6-step standardized technique with long-term follow-up.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages13

Reading Time33 min

AccessFree to download

Abstract

Purpose

Methods

Results

Conclusions

Introduction

Langenbeck's Archives of Surgery (2026) 411:40 [https://doi.org/10.1007/s00423-025-03925-z](https://doi.org/10.1007/s00423-025-03925-z) RESEARCH HIGHLIGHT A standardized robot-assisted technique for giant paraesophageal hernia repair: the relationship between surgical details and low recurrence rate in long-term follow-up Graziano Ceccarelli1,2 · Pasquale Avella3,4,5 · Gaetano Poillucci1 · Fausto Catena6 · Brian WCATian7 · Fabio Rondelli1 · Alessandro Spaziani1 · Pajtim Emini1 · Andrea Scacchi8 · Germano Guerra5 · Michele de Rosa1 · Aldo Rocca4,5 Received: 16 May 2025 / Accepted: 5 November 2025 © The Author(s) 2025 Abstract Purpose Giant Hiatal Hernia (GHH) is defined as a hiatal hernia that includes at least 30–50% of stomach in the chest. Laparoscopic approach may be challenging with high recurrence rates. Robotic surgery may overcome some laparoscopic limits, but its role is still debated. Methods We analysed a multicentric prospective database from 2011 to 2023 at General and Robotic Surgery Unit of San Giovanni Battista Hospital (Foligno-Spoleto, Italy) and General Surgery Unit of San Donato Hospital (Arezzo, Italy) . A Robotic-Assisted Repair (RAR) was performed in all cases following a standardized surgical technique consisting of 6 steps. A literature review was carried out to identify surgical details linked to better outcomes. Results 47 consecutive patients underwent RAR. Four procedures were performed in emergency setting and 2 were redosurgery. 1 (2%) conversion to open was required. Mean operative time was 158 min (range 90–235), and mean length of stay was 2.9 days (range 2–7). Fundoplication was performed in 97% of cases, while cruroplasty using pladgets in the 100% . Bioabsorbable mesh was used in 95% of patients. Anterior gastropexy or gastrostomy was made in the 85% . No patients were readmitted within 30 days, while 3 (6%) showed radiologic recurrences without clinical symptoms at long-term follow-up. Conclusions A standardized surgical technique in GHH repair achieves lower postoperative complications and recurrence rates even in a long-term follow-up. Robotic platforms allow for safer and technically easier procedures, also in emergency scenarios. Higher costs may be balanced by better postoperative outcomes when compared to conventional literature laparoscopic outcomes. Keywords Giant hiatal hernia · Robotic surgery · Fundoplication · Cruroplasty · Mesh reinforcment · Pledgets · Gastropexy · Emergency Introduction Giant Hiatal Hernia (GHH) is generally defined as a hiatal hernia in which at least 30–50% of the stomach is displaced into the chest cavity, although a uniform definition does not exist, a most recent included a stomach migration of 50% or more and a hiatus >7 cm [1, 2] . A GHH is commonly a type III hiatal hernia with a sliding and paraesophageal component [2, 3] . Nevertheless, as already reported, GHH may present a herniation of other abdominal organs such as colon, 􀀍 Pasquale Avella [avella.p@libero.it](avella.p@libero.it) 1 Division of General and Minimally Invasive Surgery, Department of Surgery, San Giovanni Battista Hospital, Foligno, Italy 2 Minimally Invasive and Robotic Surgery Unit, San Matteo Hospital, Spoleto, Italy 3 Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy 4 Hepatobiliary and Pancreatic Surgery Unit, Pineta Grande Hospital, Castel Volturno, Caserta, Italy 5 Department of Medicine and Health Science “V. Tiberio”, University of Molise, Campobasso, Italy 6 Division of General Surgery, Bufalini Hospital, Cesena, Italy 7 Department of General Surgery, Singapore General Hospital, Singapore, Singapore 8 Department of General Surgery, University of MilanoBicocca, Milan, Italy 1 3 spleen, omentum, small bowel as well as pancreas or left hepatic lobe which is classifies as type III-IV hernia [2, 4] . The most frequent symptoms are dysphagia, epigastric and/or chest pain, recurring regur

FAQs

How is giant hiatal hernia (GHH) defined in the study?

GHH is defined as a hiatal hernia including at least 30–50% of the stomach in the chest. The study notes that a uniform definition may vary across literature.

What standardized approach was used for robotic-assisted repair (RAR)?

All cases received a standardized RAR technique consisting of 6 steps. The study also reports that multiple procedural elements were applied in most patients.

What were the main long-term outcome findings after RAR?

The mean operative time was 158 minutes and mean length of stay was 2.9 days. There were no readmissions within 30 days, and radiologic recurrences without clinical symptoms occurred in 6% at long-term follow-up.

Sep 30, 2026

Upload by Asher