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1 . 2023

The results of laparoscopic and robot-assisted antireflux surgeries for hiatal hernia and gastroesophageal reflux disease

Abstract

Laparoscopic fundoplication is the standard in treatment of gastroesophageal reflux disease (GERD) and hiatal hernia (HH). The robot-assisted access option is the trend of development of the standard laparoscopic technique. 

Aim. Comparison of the results of standard laparoscopic and robot-assisted treatment of patients with HH and reflux esophagitis; assessment of the advantages of robotic technology from the position of the effectiveness of treatment and from the position of the convenience of performing the intervention by surgeons. 

Material and methods. From October 2016 to August 2022 512 patients with verified GERD on the background of HH were operated in City Clinical Hospital named after S.I. Spasokukotsky. The study groups included the patients who underwent robot-assisted fundoplication on DaVinci platform (the main group – 154 patients, 30%) and standard laparoscopic fundoplication (the control group – 358 patients, 70%). All patients underwent Nissen fundoplication with the formation of a free short wrap (“short floppy” Nissen wrap). The authors compared the intraoperative and postoperative treatment results, as well as the survey of specialists to objectify the perception of surgical techniques by the surgeons.

Results. Intraoperative complications were observed in 4 (2.6%) patients of the main group and 19 (5.3%) patients of the control group. The median duration of the surgery was 120 (70–150) minutes for robotic fundoplication and 90 (70–160) minutes for laparoscopic fundoplication. The median blood loss was 110 (50–300) ml in the main group and 135 (80–600) ml in the control group. There were no intraoperative access conversions or deaths. Postoperative complications according of grade 3b to Clavien–Dindo scale were observed in 1 (0.6%) patient in the main group and 4 (1.1%) patients in the control group. The average duration of inpatient treatment was 3.8 days in the main group and 3.6 days in the control group. All patients underwent follow-up dispensary monitoring for 1 year after surgery. The immediate results of the surgical treatment based on control studies showed positive long-term dynamics in long term in patients of both groups. Analysis of the life quality of patients according to GERD-Q showed an average score of 3.2 in both groups. According to the GSRS, patients had no complaints of abdominal pain, diarrhea and constipation providing a mean score of 1.0 in both study groups. The results of a survey of the surgeons showed the highest assessment of robot-assisted technology, especially in terms of exposure quality and fatigue during surgery. The median follow-up period for patients in the main group was 13 months, for patients in the control group – 19 months. As of 2022, there were 6 recurrences in the main group and 17 relapses in the control group, providing a total number of recurrences of 4.5%.

Conclusion. Modern minimally invasive technologies using laparoscopic and robot-assisted approaches provide optimal results in the treatment of patients with HH and GERD. The technical aspects of the formation of the fundoplication cuff should be standardized, regardless of the type of access. Robot-assisted technology provides a clear advantage in terms of operator comfort.

Keywords:hiatal hernia; antireflux surgery; laparoscopic fundoplication; robot-assisted fundoplication

Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Shestakov A.L., Erin S.A., Gololobov G.Yu., Burmistrov A.I., Ovchinnikova U.R., Chicherina M.A., Yurkuliev N.A., Gadlevskiy G.S., Dibirov M.D., Galliamov E.A. The results of laparoscopic and robot-assisted antireflux surgeries for hiatal hernia and gastroesophageal reflux disease. Clinical and Experimental Surgery. Petrovsky Journal. 2023; 11 (1): 92–103. DOI: https://doi.org/10.33029/2308-1198-2023-11-1-92-103  (in Russian)

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CHIEF EDITOR
CHIEF EDITOR
Sergey L. Dzemeshkevich
MD, Professor (Moscow, Russia)

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