Long-term outcomes of robot-assisted and laparoscopic operations for cardiofundal and subtotal hiatal hernias

Aim. To compare the long-term outcomes and qualitive of life (QOL) of robot-assisted fundoplication (RAF) and laparoscopic fundoplication (LF) in patients with cardiofundal and subtotal hiatal hernias (HH). Materials and methods. The study included 62 patients with HH, who underwent antireflux surgery in the clinic of Faculty Surgery No. 1 of Sechenov University in the period from January 2015 to February 2021. The main group included 32 patients who underwent robot-assisted fundoplication (RAF) according to A. F. Chernousov, the comparison group included 30 patients who underwent laparoscopic fundoplication (LF). Complaints of the patient, X-ray, endoscopic studies, PH-impedance-metry in the long-term period were evaluated. To assess the quality of life, the questionnaires SF 36 (The Short Form-36) and GERD-HRQL (Health-Related Quality of Life in Patients with Gastroesophageal Reflex Disease) were used. Results. Periodic heartburn in the long-term period was noted by 2 (6%) patients of the RAF group and 4 (13%) in the LF group. Endoscopic signs of mild esophagitis were detected in 1 (3%) patient from each group. X-ray in 9 (28%) patients of the RAF group and 11 (37%) patients of the LF group showed migration of the esophageal-gastric junction above the diaphragm level with complete preservation of the antireflux function of the fundoplication cuff. The QOL indicators of the SF 36 questionnaire did not differ in both groups and were comparable to the population of “conditionally healthy” people. The indicators of the GERD-HRQL questionnaire were better in the RAF group, but the differences had no statistical significance (RAF - 2.53 ± 5.1 points versus LF - 5.23 ± 9.4 points, p-value = 0.321). Conclusion. RAF and LF in the modification of A. F. Chernousov are equally effective in the treatment of RE and GPOD in the long-term period and provide good indicators of quality of life that do not differ statistically from each other.

robot-assisted fundoplication, da Vinci robotic surgical complex, laparoscopic fundoplication, hiatal hernia

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