To investigate the efficacy of robot-assisted versus laparoscopic repair for patients with hiatal hernia (HH).

A retrospective analysis was conducted on the clinical data of patients with hiatal hernia treated in the Department of Thyroid & Hernia Surgery, Medical Department of General Surgery, the First Medical Center of Chinese PLA General Hospital from March 2015 to April 2024. A total of 128 patients were included and divided into two groups based on the surgical method: the robotic group (30 cases) and the laparoscopic group (98 cases). Preoperative baseline data, perioperative data, and postoperative symptom improvement were analyzed. Patients were further stratified by age to compare the benefits of the two surgical methods across different age groups.

Compared to the laparoscopic group, the robot-assisted group exhibited less intraoperative bleeding (20.0 ml vs. 35.0 ml), shorter postoperative gas evacuation (2.0 days vs. 3.0 days), shorter postoperative hospitalization time (4.0 days vs. 5.0 days), and lower pain numerical rating scale score on the first day after surgery (3.0 points vs. 4.0 points), albeit with longer operative times (120.0 min vs. 101.5 min) and higher total hospital costs (61 564 yuan vs. 40 407 yuan), the above differences were statistically significant (P<0.05), During follow-up after surgery, symptoms improved in both groups of patients compared to preoperative conditions. Additionally, among young and mid aged patients, compared to laparoscopy, those in the robotic group experienced less intraoperative bleeding and shorter postoperative gas evacuation. However, robotic surgeries had longer operative times and incurred total hospital costs, with statistically significant differences (20.0 ml vs. 32.5 ml, 2.0 days vs. 3.0 days, 118.5 min vs. 100.0 min, 62 200 yuan vs. 40 027 yuan; P<0.05). There were no significant benefits observed in terms of postoperative hospitalization time or pain scores (P>0.05). In elderly patients, robotic-assisted surgery is associated with significantly reduced intraoperative bleeding, shorter postoperative gas evacuation, postoperative hospitalization time and lower postoperative pain scores. However, it is also linked to longer operative times and relatively higher hospitalization costs, with these differences being statistically significant (20.0 ml vs. 35.0 ml, 2.0 days vs. 3.0 days, 3.0 points vs. 4.0 points, 120.0 min vs. 110.0 min, 60 263 yuan vs. 40 749 yuan; P<0.05). Postoperative symptoms improved in both middle-aged and elderly patients compared to preoperative conditions.

Whether through laparoscopic or robot-assisted approaches, patients with hiatal hernia can benefit from surgery, However, robotic-assisted surgery offers more significant advantages for elderly patients compared to laparoscopic techniques.