Hiatal hernia after robotic-assisted coronary artery bypass graft surgery

Rami M. Abazid, Alireza Khatami, Jonathan G. Romsa, James C. Warrington, Cigdem Akincioglu, Robert Z. Stodilka, Stephanie Fox, Bob Kiaii, William C. Vezina

Research output: Contribution to journalArticlepeer-review


Background: The aim of the present study is to determine the incidence/progression of hiatal hernia (HH) after robotic-assisted coronary artery bypass grafting (RA-CABG) surgery. Methods: We reviewed the pre- and post-operative computed tomography (CT) of 491 patients who underwent RA-CABG between 2000 and 2017. Post-operative CT was acquired prospectively in a research protocol. CT was reviewed to assess the presence and the size of HH. Results: We found 444/491 (90.4%) had pre-operative CT, while 201/491 (40.9%) had post-operative CT. In total, 155/491 (31.6%) had both pre- and long-term post-operative CT with a mean follow-up of 6.2 (±3.5) years. HH was more prevalent on post-operative CT, 64/155 (41.3%) compared to pre-operative CT, 44/155 (28.4%), P<0.0001. The diameter of pre-existing HH 2.8 (±1.8) cm was significantly greater after surgery 3.9 (±2.5) cm, P<0.0001. As well the volume of the pre-existing HH 5.8 (4.4-9.2) mL (quartile) was significantly greater after surgery 14.1 (7.2-64.9) mL, P<0.0001. 20/155 (12.9%) had a newly developed HH after RA-CABG. A binary multivariate regression including HH risk factors showed that male gender is a predictor of developing a HH after RA-CABG with Hazard Ratio of 3.038, confidence interval (1.10-8.43), P=0.033. Conclusions: RA-CABG is associated with an increased risk of developing HH and increases the size of pre-existing HH.

Original languageEnglish (US)
Pages (from-to)575-581
Number of pages7
JournalJournal of Thoracic Disease
Issue number2
StatePublished - Feb 2021


  • Coronary artery bypass grafting (CABG)
  • Hiatal hernia (HH)
  • Robotic-assisted

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine


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