Hybrid hiatal hernia repair: is it cost-effective?

Fundoplication is often added to the crural repair for long-term relief of reflux in patients undergoing hiatal hernia repair. Fundoplication can be achieved surgically or with endoscopic means such as trans-oral incisionless fundoplication (TIF). Patients with hiatal hernias larger than 2 cm may undergo surgical hiatal hernia repair with concomitant TIF (hybrid repair). Our study aims to analyze the resources utilized for hybrid repair and compare it with hiatal hernia repair with surgical fundoplication (conventional repair). We conducted a retrospective review of 112 consecutive patients who underwent robotic-assisted hiatal hernia repair. Patients who underwent some form of fundoplication were selected and then divided into two groups—surgical fundoplication (conventional approach) or hybrid approach. This is a pool of patients operated by a single surgeon at a community hospital. Multiple variables were analyzed. The mean operative time was 39 min less; also the mean length of stay was 10 h less in hybrid approach group as compared to conventional repair group. Although statistically significant, there was no meaningful clinical significance to these findings. Cost analysis was performed for direct costs as well as indirect costs. Neither the 30-day outcomes nor the cost-effectiveness for hybrid repair was superior to those of conventional repair. Therefore, in our experience at the community-level hospital, we conclude that hiatal hernia repair with surgical fundoplication is more cost-effective than surgical repair of hiatal hernia with TIF.