OA10.4. Clinical Outcomes in Patients Undergoing Transoral Incisionless Fundoplication Versus Robotic Fundoplication for Gastroesophageal Reflux Disease Associated With Small Hiatal hernias

Abstract

Benign Disease: Gastro-Esophageal Reflux and Hiatal Hernia Gastroesophageal reflux disease (GERD) is a prevalent gastrointestinal disorder that often results from altered gastroesophageal junction anatomy and can result in high symptom burdens for patients. While traditional fundoplication is the gold-standard surgical intervention, transoral incisionless fundoplication (TIF) has emerged as a minimally invasive endoscopic alternative. This study aimed to compare the short- and mid-term outcomes of TIF versus robotic hiatal hernia repair (RoboHH) in patients eligible for TIF. A retrospective cohort study analyzed 76 patients with pH-confirmed GERD and hiatal hernias less than 2 cm. Preoperative assessments included manometry, pH study, esophagram, and endoscopy. Postoperative follow-up at 3 and 12 months included clinical assessment and esophagram. Statistical analysis compared demographic, preoperative, perioperative, and clinical outcomes, including symptomatic improvement, recurrence, and reintervention rates. 48 patients underwent TIF and 27 underwent RoboHH. Baseline patient characteristics and preoperative hiatal hernia sizes were comparable between TIF and RoboHH groups. Operative time was significantly shorter for TIF (67 vs. 128 minutes, p<0.001), and TIF was associated with a lower rate of postoperative admission (13% vs. 100%, p<0.001). At 3 months, symptomatic improvement was similar (80% TIF vs. 85% RoboHH, p=0.078). However, by 1 year, RoboHH demonstrated superior symptomatic improvement (89% vs. 38% for TIF, p=0.004), significantly lower symptom recurrence (0% vs. 44%, p<0.001), and lower reintervention rates (0% vs. 31%, p=0.005). TIF offers perioperative advantages with shorter operative times and fewer hospital admissions compared to robotic hiatal hernia repair. However, these benefits are offset by higher rates of symptom recurrence and reintervention within one year. RoboHH provides superior long-term durability and sustained symptom control. These findings highlight the trade-offs between invasiveness and long-term efficacy, emphasizing the importance of patient selection and potential limitations of current TIF techniques, possibly due to factors like fat interposition affecting fundoplication integrity.