Adham Elmously1, Katherine D Gray1, Timothy M Ullmann1, Thomas J Fahey1, Cheguevara Afaneh1, Rasa Zarnegar2. 1. Department of Surgery, New York Presbyterian Hospital - Weill Cornell Medicine, 1300 York Avenue, Suite A1027, New York, NY, 10065, USA. 2. Department of Surgery, New York Presbyterian Hospital - Weill Cornell Medicine, 1300 York Avenue, Suite A1027, New York, NY, 10065, USA. raz2002@med.cornell.edu.
Abstract
BACKGROUND: Laparoscopic reoperative anti-reflux surgery (ARS) has a significantly higher morbidity than laparoscopic primary ARS; however, it is not known whether the same pattern exists within the robotic approach. We aimed to evaluate the safety and efficacy of robotic reoperative ARS in comparison with primary robotic ARS. METHODS: A retrospective review of patients undergoing primary or reoperative robotic ARS at a tertiary referral center between 2012 and 2017 was performed. Perioperative outcomes and long-term symptom resolution were evaluated. RESULTS: A total of 200 patients were included (38 reoperative and 162 primary ARS). Baseline characteristics were comparable across groups. Seven (18.4%) of the reoperative patients had two or more prior foregut operations. Patients in the reoperative group had a longer operative time (226 vs. 180 min, p < 0.001). There were no conversions to open technique, and one patient in the reoperative group (2.6%) had an intraoperative perforation. Twenty of the 38 reoperative patients (52.6%) were discharged within 24 h as compared to 109/162 primary patients (64.9%) (p = 0.09). The readmission rate and postoperative complication rates were 6 and 3%, respectively, and did not differ between groups. At a mean follow-up of 1 year, complete or partial resolution of preoperative symptoms was achieved in 97% of primary patients and 100% of reoperative patients (p = 0.4). CONCLUSION: The robotic approach allows for minimal morbidity, short length of stay, and excellent functional outcomes in patients undergoing reoperative ARS when compared to patients undergoing primary ARS.
BACKGROUND: Laparoscopic reoperative anti-reflux surgery (ARS) has a significantly higher morbidity than laparoscopic primary ARS; however, it is not known whether the same pattern exists within the robotic approach. We aimed to evaluate the safety and efficacy of robotic reoperative ARS in comparison with primary robotic ARS. METHODS: A retrospective review of patients undergoing primary or reoperative robotic ARS at a tertiary referral center between 2012 and 2017 was performed. Perioperative outcomes and long-term symptom resolution were evaluated. RESULTS: A total of 200 patients were included (38 reoperative and 162 primary ARS). Baseline characteristics were comparable across groups. Seven (18.4%) of the reoperative patients had two or more prior foregut operations. Patients in the reoperative group had a longer operative time (226 vs. 180 min, p < 0.001). There were no conversions to open technique, and one patient in the reoperative group (2.6%) had an intraoperative perforation. Twenty of the 38 reoperative patients (52.6%) were discharged within 24 h as compared to 109/162 primary patients (64.9%) (p = 0.09). The readmission rate and postoperative complication rates were 6 and 3%, respectively, and did not differ between groups. At a mean follow-up of 1 year, complete or partial resolution of preoperative symptoms was achieved in 97% of primary patients and 100% of reoperative patients (p = 0.4). CONCLUSION: The robotic approach allows for minimal morbidity, short length of stay, and excellent functional outcomes in patients undergoing reoperative ARS when compared to patients undergoing primary ARS.
Authors: Omar Awais; James D Luketich; Matthew J Schuchert; Christopher R Morse; Jonathan Wilson; William E Gooding; Rodney J Landreneau; Arjun Pennathur Journal: Ann Thorac Surg Date: 2011-07-29 Impact factor: 4.330
Authors: L Grande; V Toledo-Pimentel; C Manterola; G Lacima; E Ros; J C García-Valdecasas; J Fuster; J Visa; C Pera Journal: Br J Surg Date: 1994-04 Impact factor: 6.939