ROBOTIC NISSEN FUNDOPLICATION

Gastroesophageal Reflux is a common complaint of many patients especially the elderly that causes them to feel discomfort in the chest area and perceived burning pain in the epigastric region of the abdomen especially upon eating certain foods such as chocolates or on lying down after a meal.

1. Gastroesophageal Reflux Disease and Hiatal Hernia: Surgical Management

Gastroesophageal reflux can be caused by a variety of factors such as particular food, an underlying hiatal hernia, and during pregnancy which most of the times the symptoms go away easily without treatment or with treatment with oral medications such as proton pumps inhibitors. In some cases, surgery is warranted to treat the underlying condition and the robotic Nissen fundoplication is a surgical technique that is used to address the gastroesophageal disease.

As discussed above, hiatal hernia is one of the causes of gastroesophageal reflux disease. It occurs when part or whole of the stomach protrudes through the diaphragm because of a defect in the esophageal orifice of the diaphragm. The Lower esophageal sphincter will, therefore, lie high up in the thoracic cavity, and put the individual at risk for gastric reflux. The robotic Nissen fundoplication surgery is the gold standard for treating these two conditions combined.

2. Indications

It is indicated for the treatment of severe Gastroesophageal Reflux disease which is not responsive to other modalities of treatment such as medical therapy with the oral proton pump inhibitors.
It is indicated for the treatment of hiatal hernia which is a cause of Gastroesophageal reflux disease. The robotic surgery gives a greater precision and accuracy compared to the traditional surgeons’ treatment of the condition and it is better preferred because it is a minimally invasive technique, therefore, faster healing and minimal complications are expected.

3. How is the procedure done

The Nissen fundoplication involves correcting the hiatal hernia by pulling the stomach back down into the abdomen, and wrapping part of the stomach around the esophagus. This allows food from the esophagus to get into the stomach, but prevents food or stomach acid from coming back up into the esophagus. A transabdominal approach is used in which the patient lies supine on the operating table and the robotic.

4. Risks

One of the greatest risks of the fundoplication is that it might be intensely done such that there is an over competent lower esophageal sphincter at the entry of the esophagus into the stomach. This will, as a result, seal off any gas that is present in the stomach that it cannot go up as a belch if the patient has swallowed much air. This will result in excessive passage of flatus by the patient and discomfort caused by bloating.

5. How you prepare for the surgery

The patients should be thoroughly assessed if they are fit for surgery through blood workups and history and physical examinations. The patient is required to have undergone radiological investigations such as the barium swallows to determine the extent of the underlying condition and the reports will give the surgeon a better understanding of the surgical approach that they are going to use. The patient is then given prophylactic antibiotics before the surgery is done to prevent any infections. As of any surgical procedure that you’ll be required to be under general anesthesia, the patient is required to fast for about 8-12 hours to avoid complications of the anesthesia. An intravenous line is required to feed the required drugs into the body system of the patient. A water drip may or may not be employed. Because of the nature of the surgery, the patient is required to have a temporary urinary catheter to deliver the formed urine from the urinary bladder to prevent the bladder from becoming overfull during the surgery.

6. Recovery after surgery

The recovery after the robotic post is good apart from the postoperative dysphagia (discomfort swallowing) that is experienced by some patients who have undergone is operation. In about 3 weeks the patient should be fully healed and can go back to their normal routine and work.

7. Outcomes after surgery

There are limited complications associated with this type of surgery because it provides a minimally invasive approach to the treatment of the Gastroesophageal reflux disease and any underlying hiatal hernia. It is one of the most long-lasting approaches when dealing with gastric reflux disease. A surgeon’s experience and good centers where this operation can be carried out provide better outcomes.

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