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Right Patients, Technique Boost Success in GERD Surgery
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- Guidelines for Surgical Treatment of Gastroesophageal Reflux Disease (GERD).
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Patti emphasized that " He pointed out that guidelines published in by a panel of expert gastroenterologists and surgeons recommended that a proper preoperative workup should include: Symptomatic evaluation Barium swallow Esophageal manometry hour ambulatory pH monitoring. The same panel recommended that only selected patients should undergo a gastric emptying study and combined multichannel impedance pH. The review also showed that clinical history and an upper endoscopy are not sufficient to diagnose GERD.
A wrong diagnosis of GERD can lead to drug therapy that masks other diseases such as irritable bowel syndrome, gallstone disease, and coronary artery disease. In addition, said Patti, some patients referred for surgery because they didn't respond to PPI therapy were later found to have achalasia.
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Studies also showed that the three most important predictors of successful antireflux surgery are: Presence of typical symptoms heartburn and regurgitation Good relief of symptoms with PPI therapy Presence of a pathologic amount of reflux as determined by pH monitoring. A successful antireflux operation depends on a proper preoperative workup, patient selection, surgical technique and follow-up 1.
Analysis of the Causes of Failed Antireflux Surgery and the Principles of Treatment: A Review.
All these topics have been covered-up in the papers of this especial issue. Technology has also been contributory to a successful antireflux operation from evaluation to follow-up. Surgical technique has been benefited by technology. Thus, laparoscopic access 2 , new materials to reinforce the hiatus 3 and robotic arms 4 are available today.
Robotic surgery has the advantages of 3D imaging, tremor filter, and articulated instruments and it also compensates some limitations of the laparoscopic surgery such as restricted range of motion of the instruments, and poor ergonomic positioning of the surgeon 5. Although this brings clear recompenses for certain operations, it is still elusive if operations on the esophagus, and especially at the esophagogastric junction, have real gains with a robotic platform. This review focuses on the current knowledge about antireflux robotic operations in order to evaluate if robotic arms may improve the success rate.
Although different procedures to control reflux have been made via a robotic platform 4 , fundoplication and hiatoplasty is the most common performed procedure and the subject of this review. Robotic surgery does not call for a different preoperative workup.
[Full text] Spotlight on the Linx™ Reflux Management System for the treatmen | MDER
Thus, some argue that robotic surgery should be left to complex cases and reoperative surgery not to routine cases 4 , 6 - 9. Surgical technique is not different from conventional laparoscopic surgery with the patient in a French reversed Trendelenburg position. The same steps of hiatal and distal esophageal dissection, hiatal closure and a short-floppy fundoplication 10 apply to robotic surgery. Particularly for robotic surgery adequate trocar placement and robotic arms docking must be carefully observed to avoid instruments collision.