Robot-Assisted Laparoscopic Hiatal Hernia Repair in a Patient With Right Aortic Arch: Implications for Surgical Planning and Symptom Resolution

TL;DR

A patient with a rare vascular anomaly successfully underwent robot-assisted surgery for a hiatal hernia, resolving her GERD symptoms.

Contribution

Demonstrates successful robotic-assisted surgery in a patient with a right aortic arch and refractory GERD.

Findings

Robot-assisted surgery safely managed complex vascular anatomy in a patient with a right aortic arch.

The patient experienced resolution of reflux symptoms post-surgery.

Preoperative imaging and careful planning were critical for avoiding vascular injury.

Abstract

A right aortic arch (RAA) is a rare vascular anomaly that is often asymptomatic but may present challenges during foregut surgery depending on its branching pattern and course. We present the case of a 54-year-old female with a known RAA and gastroesophageal reflux disease (GERD) refractory to maximal medical therapy. She underwent robot-assisted laparoscopic paraesophageal hiatal hernia repair. Preoperative CT imaging confirmed a right-sided descending aorta crossing midline at T11 without evidence of extrinsic esophageal compression. Surgical precautions included careful preoperative planning and intraoperative dissection to avoid vascular injury due to the aberrant anatomy. The patient recovered uneventfully and reported resolution of reflux symptoms at follow-up, confirmed by symptom assessment and improvement in diet tolerance. This case underscores the need to consider vascular anomalies when planning surgical intervention for GERD, especially in refractory cases. It highlights the role of robotic-assisted surgery in safely managing complex anatomy.

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