1. Introduction

2. Surgical Approach and Placement of Ports

3. Robot Docking

4. Exposure

5. Hernia Sac Reduction and Lipoma Dissection

6. Close Right and Left Crura with 0 V-Loc Suture

a. Shoeshine Technique

7. Fundoplication

8. Esophagogastroduodenoscopy

a. Endoclose for Port Site

b. Transversus Abdominis Plane (TAP) Block

9. Closure

10. Post-op Remarks

A hiatal hernia occurs when part of an intra-abdominal organ, most commonly the stomach, migrates through the diaphragmatic crura. The condition can cause a range of uncomfortable symptoms, including heartburn, chest pain, and difficulty swallowing. While several individuals with a hiatal hernia can manage their symptoms with lifestyle changes and anti-reflux medications, some with refractory symptoms or complications secondary to the hernia require surgical treatment to repair the defect. Here we present the case of a 60-year-old female with a paraoesophageal hiatal hernia and chronic gastrointestinal reflux disease (GERD) refractory to proton-pump inhibitors (PPI), dietary changes, and lifestyle modifications. She underwent an elective robotic hiatal hernia repair, fundoplication, and esophagogastroduodenoscopy (EGD) as a two-hour procedure with routine postprocedure recovery. This article and the associated video describe the pertinent history, evaluation, and operative steps of the procedure.

Considerations and Options for Treatment 

Watch this full-length, narrated surgical video of a robotic-assisted laparoscopic paraesophageal hiatal hernia repair with fundoplication and esophagogastroduodenoscopy performed by Dr. Charu Paranjape at Newton-Wellesley Hospital.

Newton-Wellesley Hospital