Robotic Versus Laparoscopic Hiatal Hernia Repair: A Statewide Analysis Using Severity-Graded Complication Outcomes

Background: Robotic-assisted hiatal hernia repair has increased substantially, but comparative outcomes relative to laparoscopy remain incompletely defined. Methods: We performed a retrospective cohort study using the 2024 Texas Inpatient Public Use Data File. Adult patients undergoing minimally invasive hiatal hernia repair were identified using ICD-10-PCS codes and stratified by surgical approach and mesh use. The primary outcome was major complication (Clavien-Dindo ≥III proxy). Multivariable logistic regression adjusted for demographics, comorbidity burden, admission acuity, and clinical presentation. Results: Among 3511 patients (1739 laparoscopic and 1772 robotic), major complications differed across groups, with the highest rates in robotic cases without mesh (14.4% vs. 9.3%, P =0.002). The robotic approach was associated with increased odds of major complications (aOR=1.28, 95% CI: 1.04-1.59, P =0.021), persisting in elective cases (aOR=1.38, P =0.013). No differences were observed in Clavien-Dindo ≥IV complications or mortality. Conclusions: Robotic repair was associated with increased intervention-level complications, with no differences in severe complications or mortality.