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Whether robot-assisted laparoscopic fundoplication is better for gastroesophageal reflux disease in adults: a systematic review and meta-analysis

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Abstract

Background

Although laparoscopic fundoplication is an effective, minimally invasive surgical technique for gastroesophageal reflux disease (GERD) that failed to be treated with medicine, with wide implementation its technical limitations have become increasingly clear. Recently, robot-assisted laparoscopic fundoplication (RALF) was considered a new approach that makes up for the deficiency of conventional laparoscopic fundoplication (CLF). This systematic review aimed to assess the feasibility and efficiency of robot-assisted laparoscopic fundoplication for GERD.

Methods

Two reviewers independently searched and identified seven randomized controlled trials (RCTs) and four clinical controlled trials (CCTs) of RALF versus CLF for GERD in the Cochrane database, Medline, Embase, and Science citation index between 2001 and 2009. The main outcomes were operating time, complication rate, hospital stay, and costs. The meta-analysis was performed by Review Manager 5.0 software. The effect size of the clinical outcomes was evaluated by odds ratio (OR), weighted mean difference (WMD), and standard mean difference (SMD) according to different data type. Heterogeneity and sensitivity analysis were used to account for rationality of pooling data and sources of heterogeneity.

Results

Of 483 studies found, a total of 11 trials were included in this review; among 533 patients, 198 patients underwent RALF and 335 patients underwent CLF. The results of meta-analysis showed that the postoperative complication rate (OR = 0.35, 95% CI = [0.13, 0.93], p = 0.04) is lower for RALF, but the total operating time (WMD = 24.05, 95% CI = [5.19, 42.92], p = 0.01) is longer for RALF compared with those for CLF. Statistically, there was no significant difference between the two groups with regard to perioperative complication rate (OR = 0.67, 95% CI = [0.30, 1.48], p = 1.00) and length of hospital stay (WMD = 0.00, 95% CI = [-0.25, 0.26], p = 0.04).

Conclusions

Systematic review of the literature indicates that RALF is a feasible and safe alternative to surgical treatment of GERD. However, since it lacks obvious advantages with respect to operating time, length of hospital stay and cost, RALF has limitations for its extensive application in clinics.

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Acknowledgments

We thank Ms. Yali Liu from the Evidence-based Center of Lanzhou University for assistance in the literature search and methodological quality assessment. We also thank statistician Jianzhou Wang from the School of Mathematics and Statistics of Lanzhou University for obtaining the statistical data.

Disclosures

Jun Mi, Yingxin Kang, Xiao Chen, Bingjun Wang, and Zhiping Wang have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, The Second Hospital of Lanzhou University, Lanzhou, 730030, China

    Jun Mi, Yingxin Kang, Xiao Chen, Bingjun Wang & Zhiping Wang

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Correspondence to Zhiping Wang.

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Mi, J., Kang, Y., Chen, X. et al. Whether robot-assisted laparoscopic fundoplication is better for gastroesophageal reflux disease in adults: a systematic review and meta-analysis. Surg Endosc 24, 1803–1814 (2010). https://doi.org/10.1007/s00464-009-0873-9

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