Laparoscopic hiatal hernia repair is the most common surgical approach to repairing hiatal hernias during Nissen fundoplication. The laparoscopic approach is both safe and reliable. Small incisions result in short hospital stay and fast post-operative recovery with very little pain and discomfort. More than 1000 successful laparoscopic hiatal hernia repair and Nissen fundoplication have been performed at Houston Heartburn and reflux Center with very high patient satisfaction.
Robotic hiatal hernia repair is a relatively new approach to acid reflux disease. The surgeon uses a robot to perform the procedure through tiny incisions. This approach has increased in frequency over the past few years. However, multiple studies have shown no clinical benefit in outcomes of robotic hiatal hernia repair compared to laparoscopic hiatal hernia repair. Rather, robotic hiatal hernia repair has been associated with increased surgery cost and hospital length of stay.
From a technical point of view, the robotic approach offers improved flexibility in instrument control. Tactile feedback is however limited. The ability to feel tension on tissues during mediastinal dissection improves safety. Most importantly, appreciating tension on gastric fundus tissue during fundoplication construction is crucial to avoid a tight and twisted wrap. I perform a floppy Nissen fundoplication without a calibration tube in place. I use my intuition, clinical sense, and experience to construct the most optimal wrap that best suits the patient. There is an artistic component to fundoplication surgery that may be compromised by the robotic approach. Surgery after all is an art and this is particularly true in the case of hiatal hernia repair and Nissen fundoplication surgery.