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OBJECTIVE: The Nissen fundoplication is the most common procedure performed for gastroesophageal reflux disease. This operation is associated with dysphagia and gas bloat in some patients. The normal antireflux barrier consists of a valve formed by intussusception of the esophagus into the stomach at the gastroesophageal (GE) junction. Creation of a GE valve using the surgical robot may enable a more physiologic anti−reflux procedure associated with a lower incidence of dysphagia and gas bloat.
METHODS: All patients who underwent robot−assisted GE valvuloplasty were reviewed retrospectively. Operations were performed by a single surgeon (FG) through five ports, and included robotic dissection of the esophageal hiatus, anterior and posterior closure of the hiatus, followed by intussusception of a 2−cm segment of esophagus into the stomach for 270 degrees in order to create a GE valve. Results were assessed by preoperative and postoperative endoscopy, manometry, 24 hour pH study, UGI study, subjective symptom questionnaire, and objective Viscik grading.
RESULTS: There were 68 patients (38 men, 30 women), mean age 52+/−9 years. Mean operative time was 175 + 56.7 minutes. There were 4 minor complications and no mortality. Mean hospitalization was 3.42+3.52 days (Median 1 day). 65 patients (95%) had transient postoperative dysphagia which resolved within 3 weeks. Mean follow up was 46 months. On follow up, 94% patients had a Viscik I grading and the remaining patients had a Visick II grading. Additionally, there was no gas bloat or long term dysphagia. There was no recurrence of the hiatal hernia.
CONCLUSIONS: Robot−assisted GE valvuloplasty recreates the normal anti−reflux barrier, and is associated with a low incidence of long term untoward affects. These results appear to be sustained over medium−term follow up. Although greater experience is necessary, robot−assisted GE valvuloplasty may represent a more physiologic alternative to the Nissen fundoplication.