title: Robot-Assisted Laparoscopic Hiatal Hernia Repair: Promising Anatomical and Functional Results.
abstract: BACKGROUND
  There is no consensus on the optimal technique for hiatal hernia (HH) repair, and considerable recurrence rates are reported. The aim of this study was to evaluate the perioperative outcomes, quality of life (QoL), and recurrence rate in patients undergoing robot-assisted laparoscopic HH repair.
  
  
  METHODS
  All patients who underwent robot-assisted laparoscopic HH repair between July 2011 and March 2015 were evaluated. The procedure consisted of hernia sac reduction, crural repair without mesh, and Toupet fundoplication. Postoperative radiological imaging or endoscopy was performed in all symptomatic patients to exclude recurrence. Perioperative results were collected retrospectively from the patient records. QoL was evaluated with Short Form-36 (SF-36), Gastroesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQOL), and Gastrointestinal Quality of Life Index (GIQLI) questionnaires.
  
  
  RESULTS
  A total of 40 patients were identified. The majority (75%) had a type III HH. Median operation time was 118 (62-173) minutes; median blood loss was 20 (10-934) mL, and one procedure was converted to an open procedure. In 6 (15%) patients, postoperative complications occurred, including 2 grade II and 1 grades I, III, IV, and V, according to the Clavien-Dindo classification. Median hospital stay was 3 (1-15) days. At a median follow-up of 11 months, radiological imaging was performed on indication in 12 (30%) patients, and 1 recurrence was found. Overall QoL scores were satisfactory, and there was no difference related to the time elapsed since surgery.
  
  
  CONCLUSIONS
  Robot-assisted laparoscopic HH repair followed by Toupet fundoplication demonstrated a very low short-term recurrence rate. Postoperative morbidity was minimal, and a satisfactory QoL was achieved.
authors.affiliation: Department of Surgery, University Medical Center Utrecht , Utrecht, The Netherlands .
authors.forename: Hylke J F
authors.initials: HJ
authors.lastname: Brenkman
authors.affiliation: Department of Surgery, University Medical Center Utrecht , Utrecht, The Netherlands .
authors.forename: Kevin
authors.initials: K
authors.lastname: Parry
authors.affiliation: Department of Surgery, University Medical Center Utrecht , Utrecht, The Netherlands .
authors.forename: Richard
authors.initials: R
authors.lastname: van Hillegersberg
authors.affiliation: Department of Surgery, University Medical Center Utrecht , Utrecht, The Netherlands .
authors.forename: Jelle P
authors.initials: JP
authors.lastname: Ruurda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006551:Hernia, Hiatal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012008:Recurrence; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome