Allison C Estep, MD1, Christopher J You, MD2. 1MedStar Union Memorial Hospital, 2MedStar Franklin Square Medical Center
Background: Gastroesophageal reflux disease (GERD) is a highly prevalent disorder with a multitude of treatment options ranging from lifestyle modifications and medical management to surgical options. Despite the numerous treatments available, there is still debate over which approach is most appropriate and effective for patients. This study aims to examine the effect of robotic hiatal hernia repair (RHHR) with the novel addition of esophagopexy in patients with GERD.
Methods: A single institution, single surgeon, prospectively maintained database was used to identify patients who underwent RHHR with a partial fundoplication and concomitant esophagopexy for GERD from November 2015 to July 2017. Patient characteristics, operative details and postoperative outcomes were analyzed. Primary endpoint was resolution of subjective GERD symptoms and discontinuation of proton pump inhibitor (PPI). Recurrence of hiatal hernia was a secondary endpoint.
Results: Eleven patients were identified meeting the inclusion criteria (RHHR + esophagopexy) with a mean follow-up of 9.5 weeks ± 19.4 weeks. In regards to the RHHR, 91% underwent a partial fundoplication and the additional 9% underwent a re-do wrap. This patient cohort was 81.8% female with a mean age of 61.5 ± 11.9 years. Preoperative esophagogastroduodenoscopy (EGD) was performed in 100% of patients with the study showing a hiatal hernia in 91.0%, gastritis in 45.4% and esophagitis in 63.6% of patients. Manometry was performed in 54.5% of the patients showing 50% of these patients with esophageal dysmotility. Esophagograms and pH studies were performed preoperatively in 36.4% and 45.5% of patients respectively. Preoperatively, 100% of patients had a documented diagnosis of GERD and were taking a PPI and/or H2 blocker. After RHHR with esophagopexy, 81.8% of patients had resolution of their GERD symptoms while 18.2% (n=2) remained symptomatic. However, one of two patients reported a subjective decrease in symptom severity following the procedure. Despite resolution of symptoms, 81.1% remained on PPIs. Another 9% switched to H2 blockers and one patient discontinued all antisecretory therapy. None of the patients experienced recurrence of their hiatal hernia.
Conclusion: Based on our data, RHHR with esophagopexy results in resolution GERD symptoms in over 80% of symptomatic patient. In patients with hiatal hernias and GERD, RHHR with esophagopexy does lead to resolution of symptoms, however, the majority of patients remained on PPIs. Long-term follow up is needed to investigate whether these patients are able to discontinue PPIs and remain symptom free.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88061
Program Number: P410
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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