Arcerito Massimo, Perez Martin G, Kaur Harpreet, Annoreno Kenneth M, Moon John T
Riverside Medical Clinic Inc., University of California Riverside School of Medicine, Riverside, California.
Division of General and Vascular Surgery, Riverside Community Hospital, Riverside, California.
JSLS. 2020 Jan-Mar;24(1). doi: 10.4293/JSLS.2019.00054.
Laparoscopic fundoplication is now a cornerstone in the treatment of gastro-esophageal reflux disease (GERD) with sliding hernia. The best outcomes are achieved in those patients who have some response to medical treatment compared to those who do not. Robotic fundoplication is considered a novel approach in treating GERD with large paraesophageal hiatal hernias. Our goal was to examine the feasibility of this technique.
Seventy patients (23 males and 47 females) with mean age 64 y old (22-92), preoperatively diagnosed with a large paraesophageal hiatal hernia, were treated with a robotic approach. Biosynthetic tissue absorbable mesh was applied for hiatal closure reinforcement. Fifty-eight patients underwent total fundoplication, 11 patients had partial fundoplication, and one patient had a Collis-Nissen fundoplication for acquired short esophagus.
All procedures were completed robotically, without laparoscopic or open conversion. Mean operative time was 223 min (180-360). Mean length of stay was 38 h (24-96). Median follow-up was 29 mo (7-51). Moderate postoperative dysphagia was noted in eight patients, all of which resolved after 3 mo without esophageal dilation. No mesh-related complications were detected. There were six hernia recurrences. Four patients were treated with redo-robotic fundoplication, and two were treated medically.
The success of robotic fundoplication depends on adhering to a few important technical principles. In our experience, the robotic surgical treatment of gastroesophageal reflux disease with large paraesophageal hernias may afford the surgeon increased dexterity and is feasible with comparable outcomes compared with traditional laparoscopic approaches.
腹腔镜胃底折叠术目前是治疗滑动型食管裂孔疝所致胃食管反流病（GERD）的基石。与那些对药物治疗无反应的患者相比，对药物治疗有一定反应的患者能取得最佳治疗效果。机器人辅助胃底折叠术被认为是治疗巨大食管旁裂孔疝所致GERD的一种新方法。我们的目标是检验该技术的可行性。
70例患者（23例男性，47例女性），平均年龄64岁（22 - 92岁），术前诊断为巨大食管旁裂孔疝，接受了机器人辅助手术治疗。使用生物合成可吸收组织补片加强裂孔闭合。58例患者接受了全胃底折叠术，11例患者接受了部分胃底折叠术，1例患者因后天性短食管接受了科利斯-尼森胃底折叠术。
所有手术均通过机器人完成，未转为腹腔镜手术或开放手术。平均手术时间为223分钟（180 - 360分钟）。平均住院时间为38小时（24 - 96小时）。中位随访时间为29个月（7 - 51个月）。8例患者术后出现中度吞咽困难，所有患者在3个月后未经食管扩张均恢复。未检测到与补片相关的并发症。有6例疝复发。4例患者接受了再次机器人辅助胃底折叠术治疗，2例患者接受了药物治疗。
机器人辅助胃底折叠术的成功取决于遵循一些重要的技术原则。根据我们的经验，机器人手术治疗巨大食管旁疝所致胃食管反流病可为外科医生提供更高的灵活性，并与传统腹腔镜手术方法相比具有相当的疗效，是可行的。
