Short term safety and efficacy of robot-assisted laparoscopic redo hiatal hernia repair without mesh: a retrospective cohort study

Background: Recurrent hiatal hernia remains a challenging clinical problem. Failure rates after primary repair can be as high as 59%. Symptomatic patients often require reoperation. Although minimally invasive laparoscopic surgery is the standard approach, the reported outcomes of robot-assisted redo hiatal hernia repair performed without mesh reinforcement remains limited. This study reports the safety and efficacy of robot-assisted laparoscopic redo repair without mesh. Methods: We conducted a retrospective cohort study of consecutive adult patients who underwent elective robot-assisted laparoscopic redo hiatal hernia repair across a multicentered health system from April 2016 to March 2025. Baseline demographics, comorbidities, preoperative testing, operative findings, repair technique, postoperative complications, and follow-up outcomes were collected through chart review. Primary efficacy outcomes were radiographic and symptomatic recurrences. Statistical analyses were conducted using Chi-squared for categorical variables and t-test for continuous variables. Results: Fifty-two patients were included in the final analysis. Mean age was 63±9.7 years, 60% were women, and the mean body mass index (BMI) was 30±5 kg/m2 at the time of reoperation. Most common preoperative symptoms were reflux (83%) and dysphagia (46%). The most common intraoperative finding was crural repair breakdown (73%). All procedures were completed robotically without mesh and without any conversions or intraoperative complications. The mean operative time was 224±55.1 min. The median length of stay was 2 days with interquartile range of 1 day. At a mean follow-up of 29.3±20.8 months, 88% reported improvement of symptoms, 13% completely discontinued antacid therapy, radiographic or endoscopic recurrence was observed in 38% and symptomatic recurrence in 27% with average time of discovery at 17.3±12.3 months. Only 4% required additional reoperation. Conclusions: Robot-assisted laparoscopic redo hiatal hernia repair without mesh is safe and demonstrates favorable short-term outcomes. Further comparative prospective studies are needed to clarify long term durability relative to conventional laparoscopy and mesh usage.