ArticleSurgical endoscopy2026
Unplanned conversion to open in elective laparoscopic and robotic paraesophageal hernia repair: a propensity score matched analysis of the ACS-NSQIP registry.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
introductionMinimally invasive surgery (MIS) is widely considered to be the standard of care for paraesophageal hernia (PEH) repairs, yet a subset of cases still require unplanned conversion to open surgery due to factors such as poor visualization and intraoperative complications. Although both laparoscopic and robotic approaches are routinely used, few studies have compared conversion rates as a primary outcome. This study aims to evaluate conversion to open surgery and associated short-term outcomes between surgical approaches for PEH repairs.
methodsThis retrospective cohort study used the 2022-2023 American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP) registry to identify elective laparoscopic and robotic PEH repairs in patients aged 18-90 years. Concomitant procedures were excluded and 1:1 propensity score matching was performed to control for baseline characteristics and comorbidities. The primary outcome was unplanned conversion to open surgery. Secondary outcomes included 30-day postoperative complications, return to OR, readmission, and hospital length of stay.
resultsA total of 8325 patients met inclusion criteria, of which 40% (n=3364) underwent robotic repair. After matching, 3335 patients were included in each group with balanced covariates (standardized mean difference < 0.05). The robotic group had zero conversions to open, while the laparoscopic group had a conversion rate of 0.2% (p = 0.031). Operative times were longer in the robotic group (133 vs 115 minutes, p < 0.001). No differences were observed in 30-day postoperative complications, readmission, return to OR, or median length of stay. Rates of specific complications including infections, thromboembolic events, and cardiopulmonary issues were comparable between groups.
conclusionIn this large national cohort, there was a growing trend of robot usage for elective PEH repair. Additionally, robotic repairs were associated with fewer conversions to open but longer operative time. Further studies are needed.
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