Evaluation of conventional laparoscopic versus robot-assisted laparoscopic redo hiatal hernia and antireflux surgery: a cohort study

被引：48
作者：
Tolboom R.C. [1 ,2 ]
Draaisma W.A. [1 ]
Broeders I.A.M.J. [1 ,2 ]
机构：
[1] Department of Surgery, Meander Medical Center, P.O. box 1502, Amersfoort
[2] Robotics and Minimal Invasive Surgery, University of Twente, Enschede
来源：
Journal of Robotic Surgery | 2016年 / 10卷 / 1期
关键词：
Da Vinci; Fundoplication; Gastroesophageal reflux; Redo surgery; Robotic surgical procedures;
D O I：
10.1007/s11701-016-0558-z
中图分类号：
学科分类号：
摘要：
Surgery for refractory gastroesophageal reflux disease (GERD) and hiatal hernia leads to recurrence or persisting dysphagia in a minority of patients. Redo antireflux surgery in GERD and hiatal hernia is known for higher morbidity and mortality. This study aims to evaluate conventional versus robot-assisted laparoscopic redo antireflux surgery, with the objective to detect possible advantages for the robot-assisted approach. A single institute cohort of 75 patients who underwent either conventional laparoscopic or robot-assisted laparoscopic redo surgery for recurrent GERD or severe dysphagia between 2008 and 2013 were included in the study. Baseline characteristics, symptoms, medical history, procedural data, hospital stay, complications and outcome were prospectively gathered. The main indications for redo surgery were dysphagia, pyrosis or a combination of both in combination with a proven anatomic abnormality. The mean time to redo surgery was 1.9 and 2.0 years after primary surgery for the conventional and robot-assisted groups, respectively. The number of conversions was lower in the robot-assisted group compared to conventional laparoscopy (1/45 vs. 5/30, p = 0.035) despite a higher proportion of patients with previous surgery by laparotomy (9/45 vs. 1/30, p = 0.038). Median hospital stay was reduced by 1 day (3 vs. 4, p = 0.042). There were no differences in mortality, complications or outcome. Robotic support, when available, can be regarded beneficial in redo surgery for GERD and hiatal hernia. Results of this observational study suggest technical feasibility for minimal-invasive robot-assisted redo surgery after open primary antireflux surgery, a reduced number of conversions and shorter hospital stay. © 2016, The Author(s).
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页码：33 / 39
页数：6
相关论文
共 21 条
[1]  
Pizza F., Rossetti G., Limongelli P., Del Genio G., Maffettone V., Napolitano V., Brusciano L., Russo G., Tolone S., Di Martino M., Del Genio A., Influence of age on outcome of total laparoscopic fundoplication for gastroesophageal reflux disease, World J Gastroenterol, 13, pp. 740-747, (2007)
[2]  
Draaisma W.A., Rijnhart-de Jong H.G., Broeders I.A., Smout A.J., Furnee E.J., Gooszen H.G., Five-year subjective and objective results of laparoscopic and conventional Nissen fundoplication: a randomized trial, Ann Surg, 244, pp. 34-41, (2006)
[3]  
Anvari M., Allen C., Five-year comprehensive outcomes evaluation in 181 patients after laparoscopic Nissen fundoplication, J Am Coll Surg, 196, pp. 51-57, (2003)
[4]  
Hunter J.G., Smith C.D., Branum G.D., Waring J.P., Trus T.L., Cornwell M., Galloway K., Laparoscopic fundoplication failures: patterns of failure and response to fundoplication revision, Ann Surg, 230, pp. 595-604, (1999)
[5]  
Richter J.E., Gastroesophageal reflux disease treatment: side effects and complications of fundoplication, Clin Gastroenterol Hepatol, 11, pp. 465-471, (2013)
[6]  
Zhou T., Harnsberger C., Broderick R., Fuchs H., Talamini M., Jacobsen G., Horgan S., Chang D., Sandler B., Reoperation rates after laparoscopic fundoplication, Surg Endosc, (2014)
[7]  
Furnee E.J., Broeders J.A., Draaisma W.A., Schwartz M.P., Hazebroek E.J., Smout A.J., Broeders I.A., Symptomatic and objective results of laparoscopic Nissen fundoplication after failed EndoCinch gastroplication for gastro-oesophageal reflux disease, Eur J Gastroenterol Hepatol, 22, pp. 1118-1122, (2010)
[8]  
Yamamoto S.R., Hoshino M., Nandipati K.C., Lee T.H., Mittal S.K., Long-term outcomes of reintervention for failed fundoplication: redo fundoplication versus Roux-en-Y reconstruction, Surg Endosc, 28, pp. 42-48, (2013)
[9]  
Awais O., Luketich J.D., Schuchert M.J., Morse C.R., Wilson J., Gooding W.E., Landreneau R.J., Pennathur A., Reoperative antireflux surgery for failed fundoplication: an analysis of outcomes in 275 patients, Ann Thorac Surg, 92, pp. 1083-1089, (2011)
[10]  
Furnee E.J., Draaisma W.A., Broeders I.A., Gooszen H.G., Surgical reintervention after failed antireflux surgery: a systematic review of the literature, J Gastrointest Surg, 13, pp. 1539-1549, (2009)
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