A Comparative Study Of Robot-assisted Laparoscopic And Traditional Laparoscopic Hiatal Hernia Repair Combined With Nissen Fundoplication

Objective: To compare the short-term clinical efficacy of robot-assisted laparoscopy and traditional laparoscopy in hiatal hernia repair,and to further clarify the feasibility and safety of Da Vinci robot-assisted laparoscopic repair of hiatal hernia.Methods: A retrospective analysis was performed on 110 patients with hiatal hernia who received robotic or laparoscopic repair of hiatal hernia in the People’s Hospital of Xinjiang Uygur Autonomous Region from April 2021 to July 2022 and completed postoperative follow-up with complete follow-up data table,including 70 patients in the robot group and 40 patients in the traditional laparoscopic group.Due to the epidemic impact,48 patients underwent dynamic acid and esophageal manometry 24 hours after operation,including 23 patients in the robot group and 25 patients in the traditional laparoscopic group.The operation method was abdominal approach.The results were as follows:(1)gender,weight,height,BMI,hiatal hernia type;(2)Dynamic acid measurement and esophageal manometry 24 hours after operation;(3)Preoperative and postoperative gerd Q score and GERDHRQL score(4)operative time,intraoperative blood loss,intraoperative complications,postoperative hospital stay,surgical cost,postoperative ventilation time,postoperative feeding time,postoperative painkiller use,postoperative complications;(5)Symptom follow-up,postoperative ppi administration and recurrence.A telephone follow-up was conducted to assess postoperative symptom relief and the presence or absence of recurrence in symptomatic patients.Follow-up was conducted until February2022.Results: The 110 patients included in the study ranged in age from 28 to 83 years,including 40 patients in the laparoscopic group,including 14 males and 26 females,with an average age of 58±10 years.There were 70 robots,including 33 males and 37 females,with an average age of 60±11 years old.There was no significant difference in average age between the two groups(P > 0.05),and no significant difference in gender,body mass index or hiatal hernia type between the two groups(P > 0.05).After surgery,GERDQ score,GERDHRQL score,DEMEESTER score,acid reflux times and acid reflux time of the two groups were significantly reduced,with statistical significance compared with before treatment(P < 0.05),and LESS significantly increased,with statistical significance(P<0.05).Compared with the laparoscopic group,GERDHRQL,DEMEESTER score and acid reflux time in the robot group were significantly decreased,with statistical significance(P < 0.05).Compared with the robot group,there were statistically significant differences in the mean operation time,postoperative ventilation time,postoperative eating time,postoperative average length of hospital stay,intraoperative blood loss,postoperative painkillers and postoperative ppi patients in the laparoscopic group(P<0.05),while there were no statistically significant differences in postoperative recurrence and complications(P > 0.05).Compared with the laparoscopic group,the average surgical cost of the robot group increased significantly and the difference was statistically significant(P< 0.05).Conclusions:(1)Robot-assisted laparoscopic hiatal hernia repair combined with nissen folding can achieve good anti-reflux effect in patients with hiatal hernia,significantly improve gastroesophageal reflux symptoms and quality of life in patients,and is safe and reliable,with certain feasibility.(2)Compared with traditional laparoscopy,robot-assisted laparoscopy has the advantages of shorter operation time,less intraoperative blood loss,and shorter average postoperative hospital stay.(3)Robot-assisted laparoscopy still has the problem of high surgical cost to be solved,so it is necessary to consider patients’ economic status to select surgical methods.