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Robotic-assisted approaches to GERD following sleeve gastrectomy

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Abstract

Background

Sleeve gastrectomy (SG) is the most common bariatric operation in the United States but increases the incidence of gastroesophageal reflux disease (GERD). The aim of our study was to describe our experience with robotic-assisted management of intractable GERD after SG.

Methods

A systematic review of a prospectively maintained database was performed of consecutive patients undergoing robotic-assisted magnetic sphincter augmentation placement after sleeve gastrectomy (MSA-S group) or conversion to Roux-en-Y gastric bypass (RYGB group) for GERD from 2015 to 2019 at our tertiary- care bariatric center. These were compared to a consecutive group of patients undergoing robotic-assisted magnetic sphincter augmentation placement (MSA group) for GERD without a history of bariatric surgery from 2016 to 2019. The primary outcome was perioperative morbidity. Secondary outcomes were operative time (OT), 90-day re-intervention rate, length of stay, symptom resolution and weight change.

Results

There were 51 patients included in this study; 18 patients in the MSA group, 13 patients in the MSA-S group, and 20 patients in the RYGB group. There was no significant difference in age, gender, ASA score, preoperative endoscopic findings, or DeMeester scores (P > 0.05). BMI was significantly higher in patients undergoing RYGB compared to MSA or MSA-S (P < 0.0001). There were significant differences in OT between the MSA and RYGB groups (P < 0.0001) and MSA-S and RYGB groups (P = 0.009), but not MSA group to MSA-S group (P = 0.51). There was no significant difference in intraoperative and postoperative morbidity (P = 1.0 and P = 0.60, respectively). 30-day morbidity: 5.6% (MSA), 15.4% (MSA-S) and 15% (RYGB). There was no difference on PPI discontinuation among groups, with more than 80% success rate in all.

Conclusions

The use of the robotic platform in the different approaches available for treatment of GERD after SG appears to be a feasible option with low morbidity and high success rate. Further data is needed to support our findings.

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Funding

This study was internally funded.

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Author notes

  1. Omar Bellorin and Patrick Dolan have contributed equally to this manuscript.

Authors and Affiliations

  1. Department of Surgery, New York Presbyterian Hospital – Weill Cornell Medicine, 525 East 68th St., Box 294, New York, NY, 10065, USA

    Omar Bellorin, Patrick Dolan, Mariana Vigiola-Cruz, Alfons Pomp, Gregory Dakin & Cheguevara Afaneh

  2. Department of Urology, New York Presbyterian Hospital – Weill Cornell Medicine, New York, USA

    Omar Al Hussein Alawamlh

Authors
  1. Omar Bellorin
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  2. Patrick Dolan
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  3. Mariana Vigiola-Cruz
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  4. Omar Al Hussein Alawamlh
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  5. Alfons Pomp
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  7. Cheguevara Afaneh
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Correspondence to Cheguevara Afaneh.

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Disclosures

Dr. Afaneh reports honoraria from Intuitive Surgical, outside the submitted work. Drs. Bellorin, Dolan, Vigiola-Cruz, Al Hussein, Pomp, & Dakin have no conflicts of interest or financial ties to disclose.

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Bellorin, O., Dolan, P., Vigiola-Cruz, M. et al. Robotic-assisted approaches to GERD following sleeve gastrectomy. Surg Endosc 35, 3033–3039 (2021). https://doi.org/10.1007/s00464-020-07753-8

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  • DOI: https://doi.org/10.1007/s00464-020-07753-8

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