Robotic Laparoscopic Modified Belsey Fundoplication (gastroesophageal Valvuloplasty)for Gastroesophageal Reflux Disease
Mark Meyer, MD, Barbara Tempesta, Farid Gharagozloo.
Florida Hospital Celebration Health/ University of Central Florida, Celebration, FL, USA.
Background: The Nissen fundoplication is associated with dysphasia and gas bloat, and poor long-term durability. We report the long-term results of modified Belsey Fundoplication (Gastroesophgeal Valvuloplasty) performed laparoscopically using the surgical robot. Methods: Patients who underwent robotic GE Valvuloplasty were reviewed retrospectively. Operations were performed by laparoscopy and included robotic dissection of the esophageal hiatus, primary closure of the hiatus, followed by intussusception of the 4 cm segment of the esophagus into the stomach for 270°, and suspension of the fundoplication onto the hiatal closure. Results were assessed by postoperative endoscopy, contrast esophagography, subjective Symptom Questionnaire (SQ), and objective Visick grading. Results: There were 291 patients (156 male, 135 female, Mean age 51+/-14 years). Indications were failure of medical treatment (73%) and pulmonary symptoms (27%). Mean operative time was 130 minutes +/- 52 minutes. Minor complications were seen in 21%. There was no mortality. Mean hospitalization was 2.8 days +/- 1.7 days. Mean follow-up was 85 months +/-7 months. The mean SQ score decreased from 8.3 ± 0.6 to 0.7+/ -0.2 (P < 0.05). There was no long-term dysphasia or gas bloat. 95% of patients were Visick I, and 5% Visick II. Hiatal hernia recurred in 7 patients (2%). Conclusions: Robotic laparoscopic modified Belsey fundoplication (GE Valvuloplasty) is associated with excellent long-term durability, reflux control, and low rates of dysphasia and gas bloat. This procedure may represent an alternative to medical antireflux therapy and other surgical antireflux procedures such as the Nissen fundoplication.
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