Robotic Versus Laparoscopic Hiatal Hernia Repair: A Statewide Analysis Using Severity-Graded Complication Outcomes.
Abstract
Background
Robotic-assisted hiatal hernia repair has increased substantially, but comparative outcomes relative to laparoscopy remain incompletely defined.
Methods
We performed a retrospective cohort study using the 2024 Texas Inpatient Public Use Data File. Adult patients undergoing minimally invasive hiatal hernia repair were identified using ICD-10-PCS codes and stratified by surgical approach and mesh use. The primary outcome was major complication (Clavien-Dindo ≥III proxy). Multivariable logistic regression adjusted for demographics, comorbidity burden, admission acuity, and clinical presentation.
Results
Among 3511 patients (1739 laparoscopic and 1772 robotic), major complications differed across groups, with the highest rates in robotic cases without mesh (14.4% vs. 9.3%, P=0.002). The robotic approach was associated with increased odds of major complications (aOR=1.28, 95% CI: 1.04-1.59, P=0.021), persisting in elective cases (aOR=1.38, P=0.013). No differences were observed in Clavien-Dindo ≥IV complications or mortality.
Conclusions
Robotic repair was associated with increased intervention-level complications, with no differences in severe complications or mortality.