AB069. SOH26AB_0074. Post-esophagectomy hiatal herniation following robotic-assisted minimally invasive esophagectomy: a systematic review and meta-analysis

Background: Post-esophagectomy hiatus hernias (PEHHs) are defined as the herniation of any abdominal organ(s) into the thoracic cavity via the hiatus. Presentation ranges from asymptomatic to incarceration of abdominal organs requiring emergency surgery. The influence of surgical approach on PEHH is undetermined. The incidence may be greater with minimally invasive esophagectomy (MIE) than with open esophagectomy (OE), due to reduced adhesions and a more radical trans hiatal dissection. This study aims to assess the incidence of PEHH in robotic-assisted MIE (RAMIE).

Methods: A systematic search of PubMed, Embase, OVID, and Web of Science databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Retrospective and prospective studies written between January 1990 and January 2025 describing the incidence or risk factors of PEHH were included. Incidence rates were calculated from pooled data extracted from studies.

Results: Overall incidence rate of PEHH following RAMIE was 8.5% (48/562) compared to 6.3% (371/5,892) in MIE and 3.1% (84/2,689) in OE. The overall incidence rate of PEHH following transhiatal esophagectomy was 7.8% (130/1,669) compared to 5.3% (336/6,390) in transthoracic esophagectomy. Further assessment of risk factors increasing the incidence of PEHH will be performed.

Conclusions: The risk of PEHH is highest following RAMIE, followed by MIE and OE. The numbers reporting the incidence of PEHH following RAMIE are small. Future research should focus on determining risk factors and criteria for intervention in PEHH.

Keywords: Minimally invasive esophagectomy (MIE); post-esophagectomy hiatus hernia (PEHH); robotic-assisted MIE (RAMIE); transhiatal esophagectomy; transthoracic esophagectomy