Robot-Assisted Interventions for Type II and III Sliding Hiatal Hernias Using an Advanced Method

Introduction. A hiatal hernia (HH) is a condition of weakened diaphragmatic ligaments, resulting in stretching and enlargement of the hiatal opening and protrusion of abdominal organs into the pleural cavity. In the pathogenesis of HH, one of the leading roles is played by the structural degradation of connective tissue fibers of the esophageal-diaphragmatic membrane and weakening of the ligamentous apparatus of the stomach. A common method of HH surgical treatment involves laparoscopic Nissen fundoplication combined with anterior or posterior cruroraphy. An alternative method is the use of robot-assisted surgery. Materials and methods. During the period from April 2022 to January 2024, 113 robot-assisted laparoscopic fundoplications were performed in the thoracic surgery unit at the Hospital of Bashkir State Medical University (Ufa, Russian Federation). The patients were divided into two groups. A research group (n = 65) underwent robot-assisted laparoscopic Nissen fundoplication with modified cruroraphy and cuff fixation with Z-shaped sutures according to patent 2813330C1. A control group (n = 48) had standard laparoscopic Nissen fundoplication with anterior cruroraphy using interrupted sutures. The age of operated patients ranged from 35 to 65 years, including 72 and 28% of women and men, respectively. All surgical interventions were performed using the Da Vinci Si robotic system. Results and discussion. The use of an advanced technique (patent 2813330C1) in robot-assisted interventions for type III HHs prevents cuff migration and slippage, including into the pleural cavity, as well as the occurrence of the “telescope” symptom. It helps achieve symmetry and prevent cuff deformation and slippage, as well as ensures early patient activation and initiation of enteral nutrition through the use of laparoscopic techniques and Z-shaped suture with nonabsorbable suture material. Conclusion. The positive results of surgical interventions performed for type III HHs using the developed technique (patent 2813330C1) demonstrate the proposed method promising for videoendoscopic surgery.

1. Baulin V.A., Gulyaev A.A., Baulin A.A., Baulina O.A., Averyanova L.A., Starodubtsev V.A. Long-term results of alternative antireflux surgery for gastroesophageal reflux disease and hiatal hernia. Medical Alphabet. 2024;3:50–4 (In Russ.). DOI: 10.33667/2078-5631-2024-3-50-54

2. Beretar’ R.B., Siyukhov R.Sh., Durleshter V.M., Svechkar’ I.Yu., Bykov M.I. Surgical treatment of hiatal hernia by routine and laparoscopic methods. Medical News of North Caucasus. 2019;14(3):466–8 (In Russ.). DOI: 10.14300/mnnc.2019.14112

3. Vetshev F.P., Chernousov A.F., Osminin S.V., Khorobrykh T.V., Chesarev A.A. Robot-assisted surgery in patients with giant hiatal hernia. Endoscopic surgery. 2019;25(1):5–11 (In Russ.). DOI: 10.17116/endoskop2019250115

4. Gankov V.A., Shestakov D.Yu., Andreasyan A.R., Tseymakh E.A. Videolaparoscopic surgical treatment of strangulated paraesophageal hiatal hernia (clinical observation). Acta biomedica scientifica. 2023;8(1):204–10. DOI: 10.29413/ABS.2023-8.1.20

5. Zyabreva I.A., Dzhulay T.E. Hiatal hernia: controversial, unsettled and prospective aspects (literature review). Verkhnevolzhsky medical journal. 2015;14(4):24–8 (In Russ.).

6. Kolesnikov S.A., Bugaev V.V., Bugaeva S.R., Efremov M.V., Rumbesht V.V. Complications of surgical treatment of hiatal hernia and tactics of its elimination: An observational non-randomized study. Kuban Scientific Medical Bulletin. 2024;31(3):30–43 (In Russ.). DOI: 10.25207/1608-6228-2024-31-3-30-43

7. Mozes V.G. The role of connective tissue systemic disorders in the genesis of varicose dilation of small pelvis’ veins in adolescents. Kazan medical journal. 2006;87(2):102–4 (In Russ.).

8. Rozenfeld I.I. Current issues of surgical treatment of large and giant hiatal hernias. Medical journal of the Russian Federation. 2021;27(3):291–8 (In Russ.). DOI: 10.17816/0869-2106-2021-27-3-291-298

9. Rozenfeld I.I. Methods of surgical treatment of diaphragm hernias. Notes of a scientist. 2021;11(1):60–2 (In Russ.).

10. Avzaletdinov A.M., Pavlov V.N., Vildanov T.D., Nurgudin A.A., Gibadullin I.A., Musakaeva K.R., et al. Method of fixing fundus of stomach when performing robot-assisted laparoscopic fundoplication: Russian Federation patent 2813330С1. 2024 Feb 02 (In Russ.).

11. Tumarenko A.V., Skvortsov V.V. Hiatal hernia in therapeautic practice. Crimean Journal of Internal Diseases. 2015;4:80–4 (In Russ.).

12. Khorobrykh T.V., Korotkiy V.I., Salikhov R.E., Kakotkin N.P. Surgical treatment of cardiofundal and subtotal hernias of the esophageal opening using a laparoscopic approach. Moscow surgical journal. 2018;3(61):142–3 (In Russ.).

13. Shibelgut N.M., Zaharov I.S., Mozes V.G. Clinical and biochemical manifestations of undifferentiated forms of connective tissue dysplasia in pregnant women with varicose veins of small pelvis. Saratov Journal of Medical Scientific Research. 2010;6(1):56–60.

14. Clifton M.S., Wulkan M.L. Congenital diaphragmatic hernia and diaphragmatic eventration. Clin Perinatol. 2017;44(4):773–9. DOI: 10.1016/j.clp.2017.08.011

15. El-Magd E.A., Elgeidie A., Elmahdy Y., El Sorogy M., Elyamany M.A., Abulazm I.L., et al. Impact of laparoscopic repair on type III/IV giant paraesophageal hernias: a single-center experience. Hernia. 2023;27(6):1555–70. DOI: 10.1007/s10029-023-02851-7

16. Frantzides C.T., Carlson M.A., Loizides S., Papafili A., Luu M., Roberts J., et al. Hiatal hernia repair with mesh: a survey of SAGES members. Surg Endosc. 2010;24(5):1017–24. DOI: 10.1007/s00464-009-0718-6

17. Herman A., Maiti A., Cherian S.V., Estrada-Y-Martin R.M. Heimlich maneuver-induced diaphragmatic rupture and hiatal hernia. Am J Med Sci. 2018;355(4):e13. DOI: 10.1016/j.amjms.2017.11.009

18. Inoue M., Uchida K., Otake K., Nagano Y., Mori K., Hashimoto K., et al. Thoracoscopic repair of congenital diaphragmatic hernia with countermeasures against reported complications for safe outcomes comparable to laparotomy. Surg Endosc. 2016;30(3):1014–9. DOI: 10.1007/s00464-015-4287-6

19. Luketich J.D., Raja S., Fernando H.C., Campbell W., Christie N.A., Buenaventura P.O., et al. Laparoscopic repair of giant paraesophageal hernia: 100 consecutive cases. Ann Surg. 2000;232(4):608–18. DOI: 10.1097/00000658-200010000-00016

20. Lukman K., Rudiman R., Irawan E., Nugraha P. Laparoscopic surgery of a rare giant paraesophageal hernia: a case report. Int J Surg Open. 2024;62(2):116–20. DOI: 10.1097/IO9.0000000000000041

21. Tolboom R.C., Draaisma W.A., Broeders I.A. Evaluation of conventional laparoscopic versus robot-assisted laparoscopic redo hiatal hernia and antireflux surgery: a cohort study. J Robot Surg. 2016;10(1):33–9. DOI: 10.1007/s11701-016-0558-z

22. Tyson A.F., Sola R. Jr, Arnold M.R., Cosper G.H., Schulman A.M. Thoracoscopic versus open congenital diaphragmatic hernia repair: single tertiary center review. J Laparoendosc Adv Surg Tech A. 2017;27(11):1209–16. DOI: 10.1089/lap.2017.0298