Robotic vs Laparoscopic Nissen Fundoplication: A Retrospective Case Control Study

Jan-Holly L Nicolas, MD, Renzo Garberoglio, MD, Esther Wu, MD, David B Nelson, MD, Kamran Samakar, MD, Marcos J Michelotti, MD, Keith R Scharf, DO, Jason M Wallen, MD. Loma Linda University Medical Center

Introduction: The emergence of robotic-assisted general surgical procedures continues to grow as literature on safety and feasibility becomes available. There is a little data comparing the safety and efficacy of robotic-assisted Nissen fundoplication (RN) versus conventional laparoscopic Nissen fundoplication (LN).

Objective: To compare the safety, efficacy, and feasibility RN versus LN.
Participants: A multi-surgeon, prospectively maintained database was used to identify 25 patients who underwent RN during the time period between April 2013 and August 2014. A case matched cohort of 16 LN performed during that same time period was identified for comparison. The RN cohort consisted of 19 females (76%), with a mean age of 55.1 years, and a mean BMI of 28.8. The LN cohort consisted of 10 females (62.5%), with a mean age of 60 years, and a mean BMI of 28.7.

Results: There was no statistical difference in demographic data between the two groups (including age, gender, and BMI). A hiatal hernia was identified in 68% of patients undergoing RN on either UGI study or EGD compared to 88% in the LN cohort. The mean operative time for the RN cohort was 256 minutes compared to 277 for the LN cohort (p=0.26). The mean estimated blood loss for the RN cohort was 26.2 mL compared to 26.6 mL for the LN cohort (p=0.95). The mean hospital length of stay for the RN cohort was 2.2 days compared to 1.9 for the LN cohort (p=0.4). There was one return to hospital in the RN cohort and there were no intraoperative complications or mortalities in either group. The mean follow up for the RN cohort was 240 days versus 465 days in the LN cohort (p=0.0009). Outcomes after Nissen fundoplication were similar in terms of anti-reflux medication use and reflux symptoms.

Conclusion: In our retrospective case control study there was no significant difference in operative time, estimated blood loss, hospital length of stay, or complication rate between the RN and LN cohorts. There was a statistically significant difference in mean follow up period between the two cohorts likely attributable to selection bias in selecting our matched cohort.

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