PubMed · 15396293
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H ISELIN. 1949-12-03. [Esophagoscopy].. https://pubmed.ncbi.nlm.nih.gov/15396293/
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Since January 2006, robotic assistance has been used for performing minimal invasive laparoscopic fundoplications in children. These patients were compared with those operated on with either the open surgical technique or the laparoscopic procedure. The first six children operated on with a fundoplication using the operation robot, da Vinci Surgical System from Intuitive Surgical, were included prospectively. As controls, data from the latest six children operated on using the open surgical procedure and the latest six children operated on using the minimal invasive laparoscopic technique were selected retrospectively. All the patients were operated on due to gastroesophageal reflux and were comparable in the De Meester score. The main outcome measures were the operating time, the use of postoperative analgesics, the duration of the postoperative hospital stay and the short-term outcome. There was no significant difference between the three groups concerning age, body weight and preoperative 24 h pH measurement. The mean operating time for the robotic group, 213 min, was the longer one, but the operating time for the latest four patients in the robotic group was similar to that for the laparoscopic group, 189 min. The postoperative hospital stay was shorter and a reduction in the use of analgesics postoperatively was noted. The reduction in the postoperative hospital stay and in the use of analgesics had been already noted with the introduction of the minimal invasive laparoscopic technique. There was no difference in short-term clinical outcome; the gastroesophageal reflux symptoms disappeared in all the patients. Robot-assisted laparoscopic fundoplication is comparable with the standard laparoscopic surgical procedure in terms of duration of operation, postoperative hospital stay, use of postoperative analgesics and short-term clinical outcome. The robotic surgery adds qualities to the surgical work when compared with open or laparoscopic surgery. These include better visualisation for the surgeon and greater precision in the movements of the instruments used.
A 58-year-old male patient was operated for complaints of dysphagia, anemia and retrosternal discomfort due to a type II hiatal hernia. A complete hernia sac excision and posterior crural repair was performed laparoscopically with support of the da Vincitrade mark robotic system. An antireflux procedure was not performed because of the absence of gastroesophageal reflux disease. Nine months after surgery the patient presented with recurrent complaints of dysphagia and retrosternal pain. Barium esophagram series revealed a recurrent paraesophageal hernia which was confirmed on esophagogastroscopy. A robot-assisted re-laparoscopy was performed. Left to the still intact hiatoplasty of the original operation a tear in the diaphragm, through which part of the stomach covered with peritoneum had herniated, was encountered. The hernia sac was excised, the diaphragmatic defect closed and reinforced with an expanded polytetrafluoroethylene strip of 5 x 8 cm. After surgery the patient recovered quickly, oral intake was resumed on the first postoperative day and the hospital stay was 3 days. The use of prosthetic mesh to reinforce the hiatoplasty and the addition of an antireflux procedure after hiatal hernia repair are ongoing controversial aspects of hiatal hernia repair. Reports on laparoscopic redo surgery for recurrent diaphragmatic hernia are limited and will be addressed in this case report, in perspective of the aforementioned controversial components.
Gastroesophageal reflux disease is a common disorder often requiring chronic treatment. Joining the conventional options of antisecretory medications and fundoplication, endoluminal therapies have emerged in recent years. These techniques have entered US and European markets, claiming effectiveness comparable with antireflux surgery. Nevertheless, a paucity of data is available to support that efficacy, even as more devices are coming onto the market. This review examines published reports of endoluminal reflux therapies from January 2004 to January 2005. After another year, there are still no compelling data supporting the efficacy of any of the available endoluminal treatments.