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Review
. 2023 Aug;17(4):1517-1524.
doi: 10.1007/s11701-023-01546-6. Epub 2023 Mar 2.

Robotic revision surgery after failed Nissen anti-reflux surgery: a single center experience and a literature review

Graziano Ceccarelli  1 , Manuel Valeri  2 , Lavinia Amato  2 , Michele De Rosa  1 , Fabio Rondelli  2 , Micaela Cappuccio  3 , Francesca Elvira Gambale  4 , Mariarita Fantozzi  5 , Guido Sciaudone  4 , Pasquale Avella  6   7 , Aldo Rocca  4   8
Affiliations
Review

Robotic revision surgery after failed Nissen anti-reflux surgery: a single center experience and a literature review

Graziano Ceccarelli et al. J Robot Surg. 2023 Aug.

Abstract

Background: The gastroesophageal reflux disease (GERD) worldwide prevalence is increasing maybe due to population aging and the obesity epidemic. Nissen fundoplication is the most common surgical procedure for GERD with a failure rate of approximately 20% which might require a redo surgery. The aim of this study was to evaluate the short- and long-term outcomes of robotic redo procedures after anti-reflux surgery failure including a narrative review.

Methods: We reviewed our 15-year experience from 2005 to 2020 including 317 procedures, 306 for primary, and 11 for revisional surgery.

Results: Patients included in the redo series underwent primary Nissen fundoplication with a mean age of 57.6 years (range, 43-71). All procedures were minimally invasive and no conversion to open surgery was registered. The meshes were used in five (45.45%) patients. The mean operative time was 147 min (range, 110-225) and the mean hospital stay was 3.2 days (range, 2-7). At a mean follow-up of 78 months (range, 18-192), one patient suffered for persistent dysphagia and one for delayed gastric emptying. We had two (18.19%) Clavien-Dindo grade IIIa complications, consisting of postoperative pneumothoraxes treated with chest drainage.

Conclusion: Redo anti-reflux surgery is indicated in selected patients and the robotic approach is safe when it is performed in specialized centers, considering its surgical technical difficulty.

Keywords: Anti-reflux surgery; Gastro-esophageal reflux disease; Hiatal hernia; Nissen fundoplication; Redo Nissen; Robotic fundoplication; Roux-en-Y gastric bypass; Toupet fundoplication.

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Conflict of interest statement

The authors have no conflict of interest to declare.

Figures

Fig. 1
Fig. 1
The study flowchart according to the STROBE statements. MI minimally invasive, GERD gastroesophageal reflux disease
Fig. 2
Fig. 2
a Case of slipped Nissen fundoplication (X ray swallow); b periesophageal adhesions; c dissection and anatomy restoration; d robotic partial Toupet 270° re-fundoplication
Fig. 3
Fig. 3
a Case of post-Nissen stomach herniation, periesophageal adhesions; b robotic gastric valve dissection; c hiatoplasty using pledgets; d absorbable tailored mash positioning
See this image and copyright information in PMC

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