Short-term effects of Da Vinci robot Nissen fundoplication in the treatment of refractory gastroesophageal reflux disease_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

KANG Poming , TAO Shaolin ,  TAN Qunyou , JIANG Bin , WU Licheng , FANG Chunshu , LI Qingyuan , WANG Ruwen

Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, 400042, P.R.China;

Corresponding?author：

TAN Qunyou, Email: tanqy001@163.com

Keywords：

Robot-assisted surgery; refractory gastroesophageal reflux disease; Nissen fundoplication; efficacy

DOI：

10.7507/1007-4848.201912048

Video：

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Objective To investigate the short-term effects of Da Vinci robot-assisted Nissen fundoplication in the treatment of refractory gastroesophageal reflux disease (rGERD), and to evaluate the safety and efficacy of its surgical treatment.Methods A total of 40 patients with rGERD treated by Da Vinci robot-assisted surgery from October 2016 to November 2019 in our hospital were collected. There were 23 males and 17 females at age of 34-76 (61±23) years. The related clinical data were retrospectively analyzed, and the operation skills of Da Vinci robot-assisted Nissen fundoplication with rGERD were summarized.Results There was no perioperative death or serious complication such as esophagogastric fistula. Postoperative reflux symptoms were significantly improved. DeMeester scores after surgery (39.79±35.01 points vs. 2.61±2.40 points, P=0.029), lower esophageal sphincter pressure (8.74±7.21 mm Hg vs. 24.56±8.76 mm Hg, P=0.020), integrated relaxation pressure (7.29±7.21 mm Hg vs. 16.49±9.99 mm Hg, P=0.023), distal contractile integral (600.49 ± 665.30 mm Hg·s·m vs. 510.99 ± 580.60 mm Hg·s·m, P=0.042), GERD-Q scale score (12.98±2.39 points vs. 7.59±1.11 points, P=0.033) were significantly improved compared with those before surgery. Postoperative dysphagia was found in 2 patients. And dysphagia was alleviated after diet adjustment and other treatments.Conclusion Da Vinci robot-assisted Nissen fundoplication is a safe and effective treatment for rGERD.

Citation： KANG Poming, TAO Shaolin, TAN Qunyou, JIANG Bin, WU Licheng, FANG Chunshu, LI Qingyuan, WANG Ruwen. Short-term effects of Da Vinci robot Nissen fundoplication in the treatment of refractory gastroesophageal reflux disease. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(3): 274-278. doi: 10.7507/1007-4848.201912048 Copy

1.	Vakil N, van Zanten SV, Kahrilas P, et al. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol, 2006, 101(8): 1900-1920.
2.	Yaghoobi M, Farrokhyar F, Yuan Y, et al. Is there an increased risk of GERD after Helicobacter pylori eradication? A meta-analysis. Am J Gastroenterol, 2010, 105(5): 1007-1013.
3.	Ates F, Francis DO, Vaezi MF. Refractory gastroesophageal reflux disease: advances and treatment. Expert Rev Gastroenterol Hepatol, 2014, 8(6): 657-667.
4.	Sifrim D, Zerbib F. Diagnosis and management of patients with reflux symptoms refractory to proton pump inhibitors. Gut, 2012, 61(9): 1340-1354.
5.	黃雪, 白興華. 難治性胃食管反流病治療的現狀與思考. 上海中醫藥雜志, 2018, 52(9): 6-8, 25.
6.	DeVault KR, Castell DO. Guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Practice Parameters Committee of the American College of Gastroenterology. Arch Intern Med, 1995, 155(20): 2165-2173.
7.	王康武, 劉學剛, 施超, 等. 改良 Nissen 手術在滑動性食管裂孔疝治療中的應用. 中國胸心血管外科臨床雜志, 2014, 21(5): 700-702.
8.	Cicala M, Emerenziani S, Guarino MP, et al. Proton pump inhibitor resistance, the real challenge in gastro-esophageal reflux disease. World J Gastroenterol, 2013, 19(39): 6529-6535.
9.	Anvari M, Allen C, Marshall J, et al. A randomized controlled trial of laparoscopic Nissen fundoplication versus proton pump inhibitors for the treatment of patients with chronic gastroesophageal reflux disease (GERD): 3-year outcomes. Surg Endosc, 2011, 25(8): 2547-2554.
10.	中國醫師協會外科醫師分會胃食管反流病專業委員會. 胃食管反流病外科診療共識(2019 版). 中華胃食管反流病電子雜志, 2019, 6(1): 3-9.
11.	Hu L, Yao L, Li X, et al. Effectiveness and safety of robotic-assisted versus laparoscopic hepatectomy for liver neoplasms: A meta-analysis of retrospective studies. Asian J Surg, 2018, 41(5): 401-416.
12.	Li X, Wang T, Yao L, et al. The safety and effectiveness of robot-assisted versus laparoscopic TME in patients with rectal cancer: A meta-analysis and systematic review. Medicine (Baltimore), 2017, 96(29): e7585.
13.	茍云久, 馬繼龍, 姚亮, 等. 達芬奇機器人和胸腔鏡輔助胸外科手術治療非小細胞肺癌有效性和安全性的 Meta 分析. 中國循證醫學雜志, 2017, 17(6): 661-668.
14.	周輝霞, 曹華林. 機器人輔助腹腔鏡手術在泌尿外科的應用與現狀. 中華腔鏡外科雜志(電子版), 2018, 11(2): 72-76.
15.	郭芳芳, 趙月鳴, 馮文娟, 等. 機器人與腹腔鏡手術治療早期子宮內膜癌的臨床療效對比分析. 中華腔鏡外科雜志(電子版), 2017, 10(3): 166-169.
16.	Cadiere GB, Himpens J, Vertruyen M, et al. Evaluation of telesurgical(robotic) Nissen fundoplication. Surg Endosc, 2001, 15(9): 918-923.
17.	Puri V, Felix E, Fitzgibbons RJ Jr. Laparoscopic vs conventional tension free inguinal herniorrhaphy: 2005 Society of American Gastrointestinal Endoscopic Surgeons (SAGES) annual meeting debate. Surg Endosc, 2006, 20(12): 1809-1816.
18.	Martinucci I, de Bortoli N, Giacchino M, et al. Esophageal motility abnormalities in gastroesophageal reflux disease. World J Gastrointest Pharmacol Ther, 2014, 5(2): 86-96.
19.	Gordon C, Kang JY, Neild PJ, et al. The role of the hiatus hernia in gastro-oesophageal reflux disease. Aliment Pharmacol Ther, 2004, 20(7): 719-732.
20.	張坤杰, 秦鳴放, 趙宏志, 等. 胸腔鏡 Nissen 胃底折疊術治療老年胃食管反流病. 中國中西醫結合外科雜志, 2012, 18(1): 14-17.
21.	Kelly JJ, Watson DI, Chin KF, et al. Laparoscopic Nissen fundoplication: clinical outcomes at 10 years. J Am Coll Surg, 2007, 205(4): 570-575.
22.	Robinson B, Dunst CM, Cassera MA, et al. 20 years later: laparoscopic fundoplication durability. Surg Endosc, 2015, 29(9): 2520-2524.
23.	Sugimoto M, Uotani T, Ichikawa H, et al. Gastroesophageal reflux disease in time covering eradication for all patients infected with Helicobacter pylori in Japan. Digestion, 2016, 93(1): 24-31.
24.	Du X, Hu Z, Yan C, et al. A meta-analysis of long follow-up outcomes of laparoscopic Nissen (total) versus Toupet (270°) fundoplication for gastro-esophageal reflux disease based on randomized controlled trials in adults. BMC Gastroenterol, 2016, 16(1): 88.
25.	Tsereteli Z, Sporn E, Astudillo JA, et al. Laparoscopic Nissen fundoplication is a good option in patients with abnormal esophageal motility. Surg Endosc, 2009, 23(10): 2292-2295.
26.	楊慧琪, 秦明放. 腹腔鏡胃底折疊術治療伴有精神癥狀的胃食管反流性疾病. 中國實用外科雜志, 2005, 25(10): 614-616.
27.	荀楊芹, 劉榮, 姚亮, 等. 達芬奇機器人輔助與腹腔鏡 Nissen 胃底折疊術治療成人胃食管反流病的 Meta 分析. 中華腔鏡外科雜志(電子版), 2018, 11(5): 261-267.

1. Vakil N, van Zanten SV, Kahrilas P, et al. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol, 2006, 101(8): 1900-1920.
2. Yaghoobi M, Farrokhyar F, Yuan Y, et al. Is there an increased risk of GERD after Helicobacter pylori eradication? A meta-analysis. Am J Gastroenterol, 2010, 105(5): 1007-1013.
3. Ates F, Francis DO, Vaezi MF. Refractory gastroesophageal reflux disease: advances and treatment. Expert Rev Gastroenterol Hepatol, 2014, 8(6): 657-667.
4. Sifrim D, Zerbib F. Diagnosis and management of patients with reflux symptoms refractory to proton pump inhibitors. Gut, 2012, 61(9): 1340-1354.
5. 黃雪, 白興華. 難治性胃食管反流病治療的現狀與思考. 上海中醫藥雜志, 2018, 52(9): 6-8, 25.
6. DeVault KR, Castell DO. Guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Practice Parameters Committee of the American College of Gastroenterology. Arch Intern Med, 1995, 155(20): 2165-2173.
7. 王康武, 劉學剛, 施超, 等. 改良 Nissen 手術在滑動性食管裂孔疝治療中的應用. 中國胸心血管外科臨床雜志, 2014, 21(5): 700-702.
8. Cicala M, Emerenziani S, Guarino MP, et al. Proton pump inhibitor resistance, the real challenge in gastro-esophageal reflux disease. World J Gastroenterol, 2013, 19(39): 6529-6535.
9. Anvari M, Allen C, Marshall J, et al. A randomized controlled trial of laparoscopic Nissen fundoplication versus proton pump inhibitors for the treatment of patients with chronic gastroesophageal reflux disease (GERD): 3-year outcomes. Surg Endosc, 2011, 25(8): 2547-2554.
10. 中國醫師協會外科醫師分會胃食管反流病專業委員會. 胃食管反流病外科診療共識(2019 版). 中華胃食管反流病電子雜志, 2019, 6(1): 3-9.
11. Hu L, Yao L, Li X, et al. Effectiveness and safety of robotic-assisted versus laparoscopic hepatectomy for liver neoplasms: A meta-analysis of retrospective studies. Asian J Surg, 2018, 41(5): 401-416.
12. Li X, Wang T, Yao L, et al. The safety and effectiveness of robot-assisted versus laparoscopic TME in patients with rectal cancer: A meta-analysis and systematic review. Medicine (Baltimore), 2017, 96(29): e7585.
13. 茍云久, 馬繼龍, 姚亮, 等. 達芬奇機器人和胸腔鏡輔助胸外科手術治療非小細胞肺癌有效性和安全性的 Meta 分析. 中國循證醫學雜志, 2017, 17(6): 661-668.
14. 周輝霞, 曹華林. 機器人輔助腹腔鏡手術在泌尿外科的應用與現狀. 中華腔鏡外科雜志(電子版), 2018, 11(2): 72-76.
15. 郭芳芳, 趙月鳴, 馮文娟, 等. 機器人與腹腔鏡手術治療早期子宮內膜癌的臨床療效對比分析. 中華腔鏡外科雜志(電子版), 2017, 10(3): 166-169.
16. Cadiere GB, Himpens J, Vertruyen M, et al. Evaluation of telesurgical(robotic) Nissen fundoplication. Surg Endosc, 2001, 15(9): 918-923.
17. Puri V, Felix E, Fitzgibbons RJ Jr. Laparoscopic vs conventional tension free inguinal herniorrhaphy: 2005 Society of American Gastrointestinal Endoscopic Surgeons (SAGES) annual meeting debate. Surg Endosc, 2006, 20(12): 1809-1816.
18. Martinucci I, de Bortoli N, Giacchino M, et al. Esophageal motility abnormalities in gastroesophageal reflux disease. World J Gastrointest Pharmacol Ther, 2014, 5(2): 86-96.
19. Gordon C, Kang JY, Neild PJ, et al. The role of the hiatus hernia in gastro-oesophageal reflux disease. Aliment Pharmacol Ther, 2004, 20(7): 719-732.
20. 張坤杰, 秦鳴放, 趙宏志, 等. 胸腔鏡 Nissen 胃底折疊術治療老年胃食管反流病. 中國中西醫結合外科雜志, 2012, 18(1): 14-17.
21. Kelly JJ, Watson DI, Chin KF, et al. Laparoscopic Nissen fundoplication: clinical outcomes at 10 years. J Am Coll Surg, 2007, 205(4): 570-575.
22. Robinson B, Dunst CM, Cassera MA, et al. 20 years later: laparoscopic fundoplication durability. Surg Endosc, 2015, 29(9): 2520-2524.
23. Sugimoto M, Uotani T, Ichikawa H, et al. Gastroesophageal reflux disease in time covering eradication for all patients infected with Helicobacter pylori in Japan. Digestion, 2016, 93(1): 24-31.
24. Du X, Hu Z, Yan C, et al. A meta-analysis of long follow-up outcomes of laparoscopic Nissen (total) versus Toupet (270°) fundoplication for gastro-esophageal reflux disease based on randomized controlled trials in adults. BMC Gastroenterol, 2016, 16(1): 88.
25. Tsereteli Z, Sporn E, Astudillo JA, et al. Laparoscopic Nissen fundoplication is a good option in patients with abnormal esophageal motility. Surg Endosc, 2009, 23(10): 2292-2295.
26. 楊慧琪, 秦明放. 腹腔鏡胃底折疊術治療伴有精神癥狀的胃食管反流性疾病. 中國實用外科雜志, 2005, 25(10): 614-616.
27. 荀楊芹, 劉榮, 姚亮, 等. 達芬奇機器人輔助與腹腔鏡 Nissen 胃底折疊術治療成人胃食管反流病的 Meta 分析. 中華腔鏡外科雜志(電子版), 2018, 11(5): 261-267.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Short-term effects of Da Vinci robot Nissen fundoplication in the treatment of refractory gastroesophageal reflux disease

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