Objectives: Belsey Mark IV fundoplasty is associated with less gas bloat and dysphagia compared to the Nissen wrap. Conventionally, a Belsey Mark IV fundoplasty requires a thoracotomy. Laparoscopic approaches to the Belsey procedure have not been satisfactory. By virtue of 3-D visualization and greater maneuverability, robot assistance can overcome the technical shortcomings of the laparoscopic approach.
Methods: From 1/04 to 10/08, 75 patients (41 men, 34 women, mean age 38 +/- 9 years) with gastroesophageal reflux disease underwent robot-assisted laparoscopic Belsey fundoplasty. All patients underwent preoperative manometry and 24 hour pH study. The robotic procedure was performed through the same five ports as conventional laparoscopy. 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 postoperative endoscopy, manometry, 24 hour pH study, UGI study, subjective symptom questionnaire, and objective Viscik grading.
Results: Indications: intractability (68), pulmonary complications (7). Median OR time : 3 hours. Median hospitalization : 1 day. Mean follow up was 34 months. Subjective symptomatic improvement: (maximum 12/patient) decreased from 8.6 +/- 0.6 to 0.6 +/- 0.2 (p
Program Number: P327