PURPOSE: Belsey Mark IV fundoplasty is associated with less gas bloat and dysphagia compared to the Nissen wrap. Thoracoscopic Belsey Fundoplasty is technically difficult. By virtue of 3-D visualization and greater maneuverability, the surgical robot facilitates a laparoscopic Belsey Mark IV procedure. A laparoscopic Belsey fundoplasty may represent an alternative to the Nissen procedure.
METHODS: During a 40 month period, 80 patients (41 men, 39 women, mean age 41 9 years) with gastroesophageal reflux disease underwent robot-assisted laparoscopic Belsey fundoplasty. All patients underwent preoperative manometry and 24 hour pH study. The procedure was performed through five laparoscopic ports. The hiatus was closed anteriorly and posteriorly. The esophagus was intussuscepted into the stomach by 2 cm for 270 degrees. Results were assessed by preoperative and postoperative endoscopy, manometry, 24 hour pH study, UGI study, subjective symptom questionnaire, and objective Viscik grading.
RESULTS: Indications: intractability (73), pulmonary complications (7). Median OR time : 3 hours. Median hospitalization : 1 day. Mean follow up was 28 months. Subjective symptomatic improvement:(maximum 12/patient) decreased from 8.3 0.6 to 0.7 0.2 (p<0.05). 63 patients scored 0 and were completely free of reflux symptoms. 91% were Viscick I or II. 75 patients (94%) had transient postoperative dysphagia which resolved by the third postoperative week. There was no gas bloat or long term dysphagia. Recurrent hiatal hernia was seen in 4 pts. (5%).
CONCLUSION: Robotic laparoscopic Belsey fundoplasty is feasible. This procedure is associated with a low incidence of gas bloat and dysphagia.
CLINICAL IMPLICATIONS: Although greater experience is necessary, a laparoscopic approach to the Belsey Fundoplasty may represent an alternative to the Nissen procedure.
DISCLOSURE: Farid Gharagozloo, No Financial Disclosure Information; No Product/Research Disclosure Information