Robotic hiatal hernia repair shows fewer intraoperative complications and shorter hospital stays than laparoscopic repairRobotic Surgery Shows Mixed Results for Hiatal Hernia Repair

BackgroundRobotic hiatal hernia repair (RHHR) is increasingly used, but whether its technical advantages improve perioperative safety compared with laparoscopic hiatal hernia repair (LHHR) remains uncertain. We compared the short-term safety profiles of RHHR and LHHR, with particular attention to organ-specific postoperative complications.MethodsMEDLINE (via PubMed), Web of Science, Embase, and the Cochrane Library were searched from inception through 15 July 2025 for comparative studies of RHHR and LHHR in adults. Study selection and data extraction were performed independently by two reviewers. The primary outcome was overall postoperative complications; secondary outcomes included cardiovascular, respiratory, and urological complications, dysphagia, operative time, intraoperative complications, 30-day readmission, mortality, and length of stay. Risk of bias was assessed using the Newcastle–Ottawa Scale for cohort studies, and certainty of evidence was evaluated using GRADE. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were pooled as appropriate.ResultsEleven comparative studies (10 retrospective and one prospective) involving 696,886 patients were included. Overall postoperative complications did not differ significantly between RHHR and LHHR (OR 1.14, 95% CI 0.98–1.33). RHHR was associated with fewer intraoperative complications (OR 0.42, 95% CI 0.24–0.73) and a modestly shorter hospital stay (MD −0.40 days, 95% CI −0.78–−0.02). In contrast, RHHR was associated with higher odds of cardiovascular events (OR 1.24, 95% CI 1.17–1.31), respiratory complications (OR 1.65, 95% CI 1.59–1.71), 30-day readmission (OR 1.23, 95% CI 1.19–1.27), and mortality (OR 1.26, 95% CI 1.11–1.43). No significant differences were observed for urological complications, postoperative dysphagia, or overall operative time. Certainty of evidence ranged from low to very low.ConclusionsComparative evidence identified through 15 July 2025 suggests broadly similar overall postoperative morbidity after RHHR and LHHR. RHHR may be associated with fewer intraoperative complications and a shorter hospital stay, but observed associations with higher odds of cardiopulmonary events, readmission, and mortality should be interpreted cautiously because the evidence is predominantly observational and susceptible to residual confounding, case-mix differences, and database-related bias.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251102047, PROSPERO identifier CRD420251102047.