Robotic Nissen fundoplication for gastroesophageal reflux disease: a meta-analysis of prospective randomized controlled trials
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Since its introduction, the Da Vinci surgical system for the treatment of gastroesophageal reflux disease (GERD) has been the subject of much controversy. Several prospective randomized controlled trials, conducted to assess its effectiveness and safety, have revealed differences. We performed this meta-analysis to evaluate the efficiency and safety of robotic Nissen fundoplication for GERD.
We performed a comprehensive search of PubMed, Embase, and OVID-MEDLINE, from 1950 to the present, with daily updates generated by a computer, to identify all published papers on robotic Nissen fundoplication for the treatment of GERD. The meta-analysis was performed by Review Manager Version 5.0. Differences of the overall effect were considered significant at P < 0.05 with a 95 % confidence interval (95 % CI).
Five studies with a collective total of 160 patients were included. Apart from intra-operative and post-operative complications, which were excluded because of incomplete primary data, there were no significant differences in outcomes, including of total operation interval (P = 0.16), effective operation interval (P = 0.95), post-operative dysphagia (P = 0.94), intra-operative conversion (P = 0.94), re-operation (P = 0.43), hospital stay (P = 0.97) and in-hospital costs (P = 0.08).
As current data do not clarify the advantages of the Da Vinci surgical system in Nissen fundoplication for GERD, we believe that a large a multi-center controlled trial is warranted.
KeywordsRobotic surgery Gastroesophageal reflux disease (GERD) Meta-analysis
Conflict of interest
Guoliang Yao and co-authors have no conflict of interest.
- 4.Markar SR, Karthikesalingam AP, Hagen ME, et al. Robotic vs. laparoscopic Nissen fundoplication for gastro-oesophageal reflux disease: systematic review and meta-analysis. Int J Med Robot Comput Assist Surg. 2010;6:125–31.Google Scholar
- 9.Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 (updated September 2008). The Cochrane Collaboration, 2008.Google Scholar
- 10.Review Manager (RevMan) [Computer program]. Version 5.0. Copenhagen: the Nordic Cochrane Centre, the Cochrane Collaboration; 2008.Google Scholar
- 15.Müller-Stich BP, Reiter MA, Wente MN, et al. No relevant difference in quality of life and functional outcomes at 12 month’s follow-up: a randomized controlled trail comparing robot-assisted versus conventional laparoscopic Nissen fundoplication. Langenbecks Arch Surg. 2009;394:441–6.PubMedCrossRefGoogle Scholar
- 16.The SAGES guidelines committee. Guidelines for surgical treatment of gastroesophageal reflux disease. Surg Endosc 2010 Aug 20; [Epub ahead of print]. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20725747. Accessed Aug 28, 2010.