Robotic Repair of Giant Hiatal Hernia Using Phaxis Mesh: A Case Report and Technical Description

Abstract

Background: Giant hiatal hernia is a complex surgical condition associated with distorted anatomy, significant symptoms, and high recurrence rates. Robotic-assisted surgery has emerged as an alternative to conventional laparoscopy, particularly in complex cases. Case Presentation: We report the case of an 79-year-old woman with long-standing gastrointestinal and respiratory symptoms secondary to a giant hiatal hernia, with intrathoracic migration of approximately 25% of the stomach and a hiatal defect of approximately 10.5 cm. The patient underwent elective robotic-assisted repair using the Da Vinci X system, including complete hernia reduction, anterior and posterior hiatoplasty with barbed and polyester sutures, reinforcement with a Phasix™ P4HB biosynthetic mesh in an inverted-C configuration, intraoperative endoscopy, and a floppy 360° Nissen fundoplication. Results: The procedure was completed without intraoperative complications. Postoperative recovery was uneventful, with resolution of reflux symptoms and significant improvement in dyspnea. At 6-month follow-up, no mesh-related complications or anatomical recurrence were observed. Conclusion: Robotic-assisted giant hiatal hernia repair with biosynthetic P4HB mesh reinforcement was safe and feasible in this elderly patient, providing excellent short- to mid-term outcomes. This represents one of the first reported cases in Colombia using P4HB mesh in robotic hiatal repair. Further studies are needed to define its long-term benefits.