Robotic versus Laparoscopic Hiatal Hernia Repair in Elderly Patients

Background: Minimally invasive techniques have become the preferred approach for hiatal hernia repair in elderly patients, offering reduced morbidity and shorter recovery compared with open surgery. The introduction of robotic-assisted surgery provides enhanced 3-dimensional visualization and instrument dexterity, potentially improving outcomes in complex or large hernias. However, whether these advantages translate into superior clinical results compared with conventional laparoscopy in patients over 65 years remains uncertain. This review summarizes and evaluates the evidence comparing robotic and laparoscopic hiatal hernia repair in elderly individuals. Database: A systematic review and meta-analysis were conducted using PubMed, Embase, Scopus, Web of Science, and the Cochrane Library for studies published from 2015 to 2025. Eligible randomized or observational studies comparing robotic and laparoscopic hiatal hernia repair in patients aged ≥65 years were identified according to PRISMA 2020 guidelines. Eighteen observational studies encompassing approximately 700,000 patients were included; several studies reported mixed-age cohorts, and outcomes specific to patients aged ≥65 years were extracted when available. Pooled analysis using random-effects models demonstrated no significant difference in overall complication rates (odds ratio 0.97, 95% confidence interval 0.87-1.09) or in recurrence and mortality between techniques. Robotic repair showed shorter hospital stays by approximately half a day and lower conversion-to-open rates, particularly in complex hernias. Conclusion: Robotic hiatal hernia repair demonstrates safety and efficacy comparable to laparoscopy in elderly patients, with possible benefits in complex or reoperative cases. Current evidence supports both as effective minimally invasive approaches; however, further prospective, age-specific studies are needed to validate long-term outcomes and cost-effectiveness.