Abstract：
Emergency treatment of paraesophageal hernias can be carried out through laparotomy or minimally invasive approaches, however, evidence in this regard is weak. The aim of our study was to assess safety and feasibility of the robotic-assisted treatment of paraesophageal hernias in the emergency setting. At the Bellinzona e Valli Regional Hospital, Switzerland, we conducted a retrospective analysis of patients operated on from January 2020 to January 2024 with robotic surgery for emergency presentation of paraesophageal hernias. Demographic and clinical details, operative techniques, and postoperative outcomes were collected and analyzed. Out of 82 patients who underwent robotic-assisted paraesophageal hernia repair, 17 were treated in the emergency setting. Median age was 79 years (IQR 77-85), 3 (17.6%) patients were male, and median BMI was 23.9 kg/m2 (IQR 21.0-26.0). Most frequent presentation symptoms were pain (100%), regurgitation (88.2%), and dyspnea (17.6%). No intraoperative complication, conversion to open surgery or stomach resections were recorded. Two complications of grade 3 according to the Clavien-Dindo classification and one of grade 2 occurred; all were successfully treated until resolution. The median length of hospital stay was 8 days (IQR 5-16). After a mean follow-up of 15.9 months (IQR 6.5-25.6) only two small axial asymptomatic recurrences that required no treatment. Despite limitations, our study demonstrated a very low rate of intra- and postoperative complications, likely supporting the safety and feasibility of robotic-assisted treatment for paraesophageal hernias in emergency settings. Larger studies with a control arm are needed to validate our initial findings.
摘要：
食管旁疝的急诊治疗可通过开腹手术或微创入路进行,然而,这方面的证据很薄弱。我们研究的目的是评估在紧急情况下机器人辅助治疗食道旁疝的安全性和可行性。在贝林佐纳·瓦利地区医院，瑞士,我们对2020年1月至2024年1月接受机器人手术治疗的食管旁疝急诊患者进行了回顾性分析.人口统计学和临床细节，手术技术，收集和分析术后结局.在接受机器人辅助食管旁疝修补术的82例患者中，17人在紧急情况下接受了治疗。中位年龄为79岁（IQR77-85），3例（17.6%）患者为男性，BMI中位数为23.9kg/m2（IQR21.0-26.0）。最常见的症状是疼痛（100％），返流（88.2%），和呼吸困难（17.6%）。术中无并发症,记录患者转为开腹手术或胃切除.根据Clavien-Dindo分类，发生了两种3级并发症和一种2级并发症；所有患者均成功治疗直至消退。平均住院时间为8天（IQR5-16）。平均随访15.9个月（IQR6.5-25.6）后，仅有两次小的轴向无症状复发，无需治疗。尽管有局限性,我们的研究表明，术中和术后并发症的发生率非常低，可能支持在紧急情况下机器人辅助治疗食道旁疝的安全性和可行性。需要使用控制臂进行更大的研究来验证我们的初步发现。
