Robotic Nissen fundoplication for gastroesophageal reflux disease: a meta-analysis of prospective randomized controlled trials.

PURPOSE

Since its introduction, the Da Vinci surgical system for the treatment of gastroesophageal reflux disease (GERD) has been the subject of much controversy. Several prospective randomized controlled trials, conducted to assess its effectiveness and safety, have revealed differences. We performed this meta-analysis to evaluate the efficiency and safety of robotic Nissen fundoplication for GERD.

METHODS

We performed a comprehensive search of PubMed, Embase, and OVID-MEDLINE, from 1950 to the present, with daily updates generated by a computer, to identify all published papers on robotic Nissen fundoplication for the treatment of GERD. The meta-analysis was performed by Review Manager Version 5.0. Differences of the overall effect were considered significant at P < 0.05 with a 95 % confidence interval (95 % CI).

RESULTS

Five studies with a collective total of 160 patients were included. Apart from intra-operative and post-operative complications, which were excluded because of incomplete primary data, there were no significant differences in outcomes, including of total operation interval (P = 0.16), effective operation interval (P = 0.95), post-operative dysphagia (P = 0.94), intra-operative conversion (P = 0.94), re-operation (P = 0.43), hospital stay (P = 0.97) and in-hospital costs (P = 0.08).

CONCLUSIONS

As current data do not clarify the advantages of the Da Vinci surgical system in Nissen fundoplication for GERD, we believe that a large a multi-center controlled trial is warranted.