Robot-assisted surgery combined with enhanced recovery after surgery in the treatment of hiatal hernia in children.

Abstract

To explore the efficacy of combining robot-assisted surgery with perioperative measures of enhanced recovery after surgery in children with hiatal hernia. Seventy-two children with hiatal hernia who underwent surgical treatment in our department between January 2014 and December 2024 were retrospectively enrolled. The patients were divided into 3 groups according to the period of admission. Group A (n = 29) received conventional laparoscopic surgery and conventional perioperative management; group B (n = 27) received conventional laparoscopic surgery and the enhanced recovery after surgery protocol; and group C (n = 16) received robotic-assisted surgery and the enhanced recovery after surgery protocol. The collected data included age at surgery, weight at surgery, operation time, intraoperative blood loss, postoperative inflammatory markers, time to first postoperative bowel movement, postoperative pain assessment, postoperative hospital stay, postoperative complications, and hospitalization costs. No significant differences were observed in age at surgery, weight at surgery, and operative time (P > .05). Group C was associated with a significantly reduced intraoperative blood loss compared with groups A and B (P < .05). Groups B and C were associated with a significantly shorter postoperative hospital stay and an earlier time to first postoperative bowel movement compared with group A (P < .05). No statistically significant difference was observed in the complication rates among the 3 groups (P > .05). The hospitalization cost in group C was significantly higher than that in groups A and B (P < .05). As for inflammatory markers, the C-reactive protein level on postoperative day 1 was significantly lower in groups B and C compared with group A (P < .05), whereas the white blood cell levels did not differ significantly among the 3 groups (P > .05). Comparisons of postoperative pain scores among the 3 groups revealed that groups B and C had significantly lower scores at both 6 and 24 hours postoperatively compared with group A (P < .05). Robot-assisted surgery in the treatment of hiatal hernia in children demonstrates safety and efficacy, offering distinct advantages in meticulous anatomic exposure and accurate suturing. In combination with the enhanced recovery after surgery protocol, it reduces surgical trauma, alleviates postoperative pain, and promotes early recovery. This combined approach is recommended for clinical application.