Comparison of da Vinci Robot-Assisted and Conventional Laparoscopic Surgery for Hiatal Hernia in Children after Repair for Esophageal Atresia

Objective: To compare the effectiveness and safety of da Vinci robot-assisted and conventional laparoscopic surgery for hiatal hernia (HH) treatment in children after repair of esophageal atresia (EA). Methods: A retrospective analysis was conducted of 54 children with EA who underwent either conventional or robot-assisted laparoscopic HH repair between January 2018 and December 2023 in our center. Clinical characteristics and postoperative outcomes were compared to explore the effectiveness and safety of both surgical methods. Results: Fifty-four patients (conventional surgery, n = 32; robot-assisted surgery, n = 22) met the inclusion criteria. No significant difference was found in gender, age, EA repair method, main symptoms, HH type, and previous HH repair between the two groups. Type A EA accounted for more proportion in conventional surgery group (43.8% versus 13.6%, P < .05). There was a higher use of Nissen fundoplication in robot-assisted surgery group (78.1% versus 100%, P < .05). No significant difference was found in terms of operation length, blood loss, time to start enteral nutrition, conversion to open and total, or postoperative length of stay. The incidence of recurrent symptoms, especially reflux during nighttime, was significantly higher in conventional surgery group (31.3% versus 0%, P < .05). No severe complication or death was reported in either group. Conclusions: Robot-assisted laparoscopic surgery can be performed safely and effectively for HH repair in EA patients, which made Nissen fundoplication more feasible and showed superior control of reflux symptoms than conventional laparoscopic surgery.