Robot Assisted Gastroesophageal Valvuloplasty: An Alternative Anti-Reflux Surgical Procedure

Mohammed Kalan, MD, Mark Meyer, MD, Marc Margolis, MD, Barbara Tempesta, CRNP, Eric Strother, CSA, Farid Gharagozloo, MD

The Washington Institute of Thoracic and Cardiovascular Surgery and the Washington Surgical Institute at The George Washington University Medical Center, Washington, DC. The University of Arizona College of Medicine, Tucson, AZ

INTRODUCTION: The normal antireflux barrier consists of a valve which is formed by the intussusception of the esophagus into the stomach at the gastroesophageal junction. Creation of a gastroesophageal valve using the surgical robot, may enable a more ‘physiologic’ anti-reflux procedure, associated with a lower incidence of dysphagia and gas bloat.

METHODS: Over 83 months, 52 patients with gastroesophageal reflux disease underwent robot-assisted gastroesophageal valvuloplasty. All patients underwent pre-operative manometry and 24 hour pH study. The procedure was performed through five laparoscopic ports. The hiatus was closed anteriorly and posteriorly. The esophagus was ‘intussuscepted’ into the stomach by 2 cm for 270 degrees. Results were assessed by preoperative and intraoperative post procedure endoscopy, manometry, 24 hour pH study, UGI study, subjective symptom questionnaire, and objective Viscik grading.

RESULTS: There were 35 women and 17 men (Age 55 +/- 17 years). Mean operative time was 174 +/- 52 minutes. 1 patient (2%) had supraventricular tachycardia postoperatively. There was no mortality. Median hospitalization was 2 days. 23 patients (44%) had transient postoperative dysphagia which resolved by the third postoperative week. On median follow up of 24 months, 78% patients had a Viscik I grading and the remaining patients had a Visick II grading. Additionally, there was no gas bloat or long term dysphagia. No recurrence of hiatal hernia has been noted.

CONCLUSION: Robot assisted gastroesophageal valvuloplasty is associated with symptom resolution and a low incidence of gas bloat and dysphagia. The results appear to be sustained in a medium term follow up.

Session: Poster Presentation

Program Number: P636

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