Department of Surgery, New York Presbyterian Hospital - Weill Cornell Medicine, 525 East 68th St., Box 294, New York, NY, 10065, USA.
Department of Urology, New York Presbyterian Hospital - Weill Cornell Medicine, New York, USA.
Surg Endosc. 2021 Jun;35(6):3033-3039. doi: 10.1007/s00464-020-07753-8. Epub 2020 Jun 22.
Sleeve gastrectomy (SG) is the most common bariatric operation in the United States but increases the incidence of gastroesophageal reflux disease (GERD). The aim of our study was to describe our experience with robotic-assisted management of intractable GERD after SG.
A systematic review of a prospectively maintained database was performed of consecutive patients undergoing robotic-assisted magnetic sphincter augmentation placement after sleeve gastrectomy (MSA-S group) or conversion to Roux-en-Y gastric bypass (RYGB group) for GERD from 2015 to 2019 at our tertiary- care bariatric center. These were compared to a consecutive group of patients undergoing robotic-assisted magnetic sphincter augmentation placement (MSA group) for GERD without a history of bariatric surgery from 2016 to 2019. The primary outcome was perioperative morbidity. Secondary outcomes were operative time (OT), 90-day re-intervention rate, length of stay, symptom resolution and weight change.
There were 51 patients included in this study; 18 patients in the MSA group, 13 patients in the MSA-S group, and 20 patients in the RYGB group. There was no significant difference in age, gender, ASA score, preoperative endoscopic findings, or DeMeester scores (P > 0.05). BMI was significantly higher in patients undergoing RYGB compared to MSA or MSA-S (P < 0.0001). There were significant differences in OT between the MSA and RYGB groups (P < 0.0001) and MSA-S and RYGB groups (P = 0.009), but not MSA group to MSA-S group (P = 0.51). There was no significant difference in intraoperative and postoperative morbidity (P = 1.0 and P = 0.60, respectively). 30-day morbidity: 5.6% (MSA), 15.4% (MSA-S) and 15% (RYGB). There was no difference on PPI discontinuation among groups, with more than 80% success rate in all.
The use of the robotic platform in the different approaches available for treatment of GERD after SG appears to be a feasible option with low morbidity and high success rate. Further data is needed to support our findings.
袖状胃切除术（SG）是美国最常见的减重手术，但会增加胃食管反流病（GERD）的发病率。我们研究的目的是描述我们在袖状胃切除术后使用机器人辅助治疗难治性 GERD 的经验。
对 2015 年至 2019 年期间，在我们的三级护理减重中心，连续进行机器人辅助磁性括约肌增强术（MSA）治疗胃食管反流病（GERD）的患者进行前瞻性数据库的系统回顾，这些患者分为袖状胃切除术（MSA-S 组）或转换为 Roux-en-Y 胃旁路术（RYGB 组）后进行机器人辅助 MSA 的患者组（n=13），或无减重手术史的患者行机器人辅助 MSA 治疗 GERD 组（MSA 组）（n=18）。将这些与 2016 年至 2019 年期间连续进行机器人辅助 MSA 治疗 GERD 而无减重手术史的患者进行比较。主要结局是围手术期发病率。次要结局包括手术时间（OT）、90 天再干预率、住院时间、症状缓解和体重变化。
本研究共纳入 51 例患者；MSA 组 18 例，MSA-S 组 13 例，RYGB 组 20 例。年龄、性别、ASA 评分、术前内镜检查结果和 DeMeester 评分无显著差异（P＞0.05）。与 MSA 或 MSA-S 组相比，RYGB 组的 BMI 显著更高（P＜0.0001）。MSA 组与 RYGB 组之间（P＜0.0001）和 MSA-S 组与 RYGB 组之间（P=0.009）OT 存在显著差异，但 MSA 组与 MSA-S 组之间（P=0.51）无差异。术中及术后发病率无显著差异（P=1.0 和 P=0.60）。30 天发病率：5.6%（MSA）、15.4%（MSA-S）和 15%（RYGB）。各组 PPI 停药率无差异，成功率均超过 80%。
在袖状胃切除术后治疗 GERD 的不同方法中使用机器人平台似乎是一种可行的选择，具有低发病率和高成功率。需要进一步的数据来支持我们的研究结果。
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