title: Robotic repair of giant paraesophageal hernias.
abstract: OBJECTIVE
  Giant paraesophageal hernia accounts for 5% of all hiatal hernias, and it is commonly seen in elderly patients with comorbidities. Some series report complication rates up to 28%, recurrence rates between 10% and 25%, and a mortality rate close to 2%. Recently, the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) has shown equivocal benefits when used for elective surgeries, whereas for complex procedures, the benefits appear to be clearer. The purpose of this study is to present our preliminary experience in robotic giant paraesophageal hernia repair.
  
  
  METHODS
  We retrospectively collected data from patients who had a diagnosis of giant paraesophageal hernia and underwent a paraesophageal hernia repair with the da Vinci Surgical System.
  
  
  RESULTS
  Nineteen patients (12 women [63.1%]) underwent surgery for giant paraesophageal hernia at our center. The mean age was 70.4 ± 13.9 years (range, 40-97 years). The mean American Society of Anesthesiologists score was 2.15. The mean surgical time and hospital length of stay were 184.5 ± 96.2 minutes (range, 96-395 minutes) and 4.3 days (range, 2-22 days), respectively. Nissen fundoplications were performed in 3 cases (15.7%), and 16 patients (84.2%) had mesh placed. Six patients (31.5%) presented with gastric volvulus, and 2 patients had other herniated viscera (colon and duodenum). There were 2 surgery-related complications (10.5%) (1 dysphagia that required dilatation and 1 pleural injury) and 1 conversion to open repair (partial gastric resection). No recurrences or deaths were observed in this series.
  
  
  CONCLUSIONS
  In our experience robotic giant paraesophageal hernia repair is not different from the laparoscopic approach in terms of complications and mortality rate, but it may be associated with lower recurrence rates. However, larger series with longer follow-up are necessary to further substantiate our results.
authors.affiliation: Department of General and Bariatric Surgery, Baptist Health South Florida, Miami, FL, USA.
authors.forename: Rupa
authors.initials: R
authors.lastname: Seetharamaiah
authors.affiliation: Department of General and Bariatric Surgery, Baptist Health South Florida, Miami, FL, USA.
authors.forename: Rey Jesús
authors.initials: RJ
authors.lastname: Romero
authors.affiliation: Department of General and Bariatric Surgery, Baptist Health South Florida, Miami, FL, USA.
authors.forename: Radomir
authors.initials: R
authors.lastname: Kosanovic
authors.affiliation: Center for Research & Grants, Baptist Health South Florida, Miami, FL, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Gallas
authors.affiliation: Department of General and Bariatric Surgery, Baptist Health South Florida, Miami, FL, USA.
authors.forename: Juan-Carlos
authors.initials: JC
authors.lastname: Verdeja
authors.affiliation: Department of General and Bariatric Surgery, Baptist Health South Florida, Miami, FL, USA.
authors.forename: Jorge
authors.initials: J
authors.lastname: Rabaza
authors.affiliation: Department of General and Bariatric Surgery, Baptist Health South Florida, 7800 SW 87th Ave, Ste B210, Miami, FL 33173, USA. anthonyg@baptisthealth.net.
authors.forename: Anthony Michael
authors.initials: AM
authors.lastname: Gonzalez
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006551:Hernia, Hiatal / Q000473:pathology / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012371:Robotics