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.	黄雪, 白兴华. 难治性胃食管反流病治疗的现状与思考. 上海中医药杂志, 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, 刘学刚, 施超, 等. 改良 Nissen 手术在滑动性食管裂孔疝治疗中的应用. 中国胸心血管外科临床杂志, 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.	中国医师协会外科医师分会胃食管反流病专业委员会. 胃食管反流病外科诊疗共识(2019 版). 中华胃食管反流病电子杂志, 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.	苟云久, 马继龙, 姚亮, 等. 达芬奇机器人和胸腔镜辅助胸外科手术治疗非小细胞肺癌有效性和安全性的 Meta 分析. 中国循证医学杂志, 2017, 17(6): 661-668.
14.	周辉霞, 曹华林. 机器人辅助腹腔镜手术在泌尿外科的应用与现状. 中华腔镜外科杂志(电子版), 2018, 11(2): 72-76.
15.	郭芳芳, 赵月鸣, 冯文娟, 等. 机器人与腹腔镜手术治疗早期子宫内膜癌的临床疗效对比分析. 中华腔镜外科杂志(电子版), 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.	张坤杰, 秦鸣放, 赵宏志, 等. 胸腔镜 Nissen 胃底折叠术治疗老年胃食管反流病. 中国中西医结合外科杂志, 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.	杨慧琪, 秦明放. 腹腔镜胃底折叠术治疗伴有精神症状的胃食管反流性疾病. 中国实用外科杂志, 2005, 25(10): 614-616.
27.	荀杨芹, 刘荣, 姚亮, 等. 达芬奇机器人辅助与腹腔镜 Nissen 胃底折叠术治疗成人胃食管反流病的 Meta 分析. 中华腔镜外科杂志(电子版), 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. 黄雪, 白兴华. 难治性胃食管反流病治疗的现状与思考. 上海中医药杂志, 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, 刘学刚, 施超, 等. 改良 Nissen 手术在滑动性食管裂孔疝治疗中的应用. 中国胸心血管外科临床杂志, 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. 中国医师协会外科医师分会胃食管反流病专业委员会. 胃食管反流病外科诊疗共识(2019 版). 中华胃食管反流病电子杂志, 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. 苟云久, 马继龙, 姚亮, 等. 达芬奇机器人和胸腔镜辅助胸外科手术治疗非小细胞肺癌有效性和安全性的 Meta 分析. 中国循证医学杂志, 2017, 17(6): 661-668.
14. 周辉霞, 曹华林. 机器人辅助腹腔镜手术在泌尿外科的应用与现状. 中华腔镜外科杂志(电子版), 2018, 11(2): 72-76.
15. 郭芳芳, 赵月鸣, 冯文娟, 等. 机器人与腹腔镜手术治疗早期子宫内膜癌的临床疗效对比分析. 中华腔镜外科杂志(电子版), 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. 张坤杰, 秦鸣放, 赵宏志, 等. 胸腔镜 Nissen 胃底折叠术治疗老年胃食管反流病. 中国中西医结合外科杂志, 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. 杨慧琪, 秦明放. 腹腔镜胃底折叠术治疗伴有精神症状的胃食管反流性疾病. 中国实用外科杂志, 2005, 25(10): 614-616.
27. 荀杨芹, 刘荣, 姚亮, 等. 达芬奇机器人辅助与腹腔镜 Nissen 胃底折叠术治疗成人胃食管反流病的 Meta 分析. 中华腔镜外科杂志(电子版), 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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