Elmously Adham, Gray Katherine D, Ullmann Timothy M, Fahey Thomas J, Afaneh Cheguevara, Zarnegar Rasa
Department of Surgery, New York Presbyterian Hospital - Weill Cornell Medicine, 1300 York Avenue, Suite A1027, New York, NY, 10065, USA.
World J Surg. 2018 Dec;42(12):4014-4021. doi: 10.1007/s00268-018-4708-5.
Laparoscopic reoperative anti-reflux surgery (ARS) has a significantly higher morbidity than laparoscopic primary ARS; however, it is not known whether the same pattern exists within the robotic approach. We aimed to evaluate the safety and efficacy of robotic reoperative ARS in comparison with primary robotic ARS.
A retrospective review of patients undergoing primary or reoperative robotic ARS at a tertiary referral center between 2012 and 2017 was performed. Perioperative outcomes and long-term symptom resolution were evaluated.
A total of 200 patients were included (38 reoperative and 162 primary ARS). Baseline characteristics were comparable across groups. Seven (18.4%) of the reoperative patients had two or more prior foregut operations. Patients in the reoperative group had a longer operative time (226 vs. 180 min, p < 0.001). There were no conversions to open technique, and one patient in the reoperative group (2.6%) had an intraoperative perforation. Twenty of the 38 reoperative patients (52.6%) were discharged within 24 h as compared to 109/162 primary patients (64.9%) (p = 0.09). The readmission rate and postoperative complication rates were 6 and 3%, respectively, and did not differ between groups. At a mean follow-up of 1 year, complete or partial resolution of preoperative symptoms was achieved in 97% of primary patients and 100% of reoperative patients (p = 0.4).
The robotic approach allows for minimal morbidity, short length of stay, and excellent functional outcomes in patients undergoing reoperative ARS when compared to patients undergoing primary ARS.
腹腔镜再次抗反流手术（ARS）的发病率显著高于腹腔镜初次抗反流手术；然而，机器人手术方式是否存在同样的情况尚不清楚。我们旨在评估机器人再次抗反流手术与初次机器人抗反流手术相比的安全性和有效性。
对2012年至2017年在一家三级转诊中心接受初次或再次机器人抗反流手术的患者进行回顾性研究。评估围手术期结果和长期症状缓解情况。
共纳入200例患者（38例再次手术患者和162例初次抗反流手术患者）。各组基线特征具有可比性。7例（18.4%）再次手术患者曾接受过两次或更多次先前的前肠手术。再次手术组患者的手术时间更长（226分钟对180分钟，p<0.001）。没有转为开放手术的情况，再次手术组有1例患者（2.6%）术中穿孔。38例再次手术患者中有20例（52.6%）在24小时内出院，而初次手术患者中有109/162例（64.9%）（p=0.09）。再入院率和术后并发症发生率分别为6%和3%，两组之间无差异。平均随访1年时，97%的初次手术患者和100%的再次手术患者术前症状完全或部分缓解（p=0.4）。
与接受初次抗反流手术的患者相比，机器人手术方式使再次抗反流手术患者的发病率降至最低，住院时间缩短，功能结局良好。
