Acta Chir Belg. 2026 Jan 2:1-14. doi: 10.1080/00015458.2025.2611452. Online ahead of print.
ABSTRACT
Background Laparoscopic hiatal hernia repair is considered the golden standard. Since its entrance in the mid ’00s, robotic surgery has been available in every modern operating center. The aim of this systematic review and meta-analyses is to compare laparoscopic versus robotic surgical hiatal hernia repair regarding clinically relevant postoperative complications, using the Clavien Dindo score 3.Methods After registration in PROSPERO, a literature review was performed following the PRISMA flow diagram, resulting in eleven studies. Their quality was assessed using the Newcastle-Ottowa scale. Risk of bias was assessed using the ROBINS-I tool. Statistical analysis was performed using Python. The primary outcome was Clavien Dindo score 3, the secondary outcomes were mortality, intraoperative complications, postoperative complications, length of stay and operation time.Results Eleven studies (182.467 patients in total, 12.056 robotic surgical repair) were analyzed. The meta-analysis showed no statistically significant result between CD score 3 (OR = 0,68 (95% CI 0,27 – 1,72)). From the investigated secondary outcomes, only intraoperative complications showed a significant difference favoring robotic repair (OR = 0,41 (95% CI 0,22 – 0,76) and p-value = 0,005).Conclusion Robotic hiatal hernia repair shows less intraoperative complications in comparison to laparoscopic repair. With the current available literature, no difference in Clavien Dindo score 3 is seen. To investigate the full potential of robotic surgery, prospective studies should be performed with surgeons who have passed their learning curve. Subgroup analyses regarding giant hiatal hernia and redo surgery should be performed. A uniform definition of ‘giant’ hiatal hernia is needed.
PMID:41481122 | DOI:10.1080/00015458.2025.2611452
