Effectiveness of robotic assisted laparoscopic nissen fundoplication in neurologically impaired children with severe gastroesophageal reflux disease

Abstract

Laparoscopic Nissen Fundoplication is still the most widely used surgical technique in the treatment of gastroesophageal reflux disease (GERD) in children. However, there are some technical and anatomical difficulties in the treatment of reflux in NIC with GERD. All these difficulties lead to the high rate of surgical failure observed in neurological impaired children (NIC). Robotic surgery provides several advantages in overcoming these difficulties. This study is the first study to evaluate the effectiveness of robotic surgery in the treatment of GERD in children with severe or moderate neurological impairments reported in Turkey. This study took place between January 2018 and February 2020. We retrospectively evaluated the records of eleven children with severe or moderate neurological problems who were treated using the robotically assisted laparoscopic Nissen fundoplication (RALNF) technique for demographic data, anesthesia time, pre-console time, console time, and postoperative complications. Nine of the patients (81.8%) had serious and two had moderate neurological problems. All of the patients applied to the emergency department at different times due to recurrent lung infections. While the first RALNF console time was 240 minutes, this study revealed that this time decreased to 45 minutes. None of the patients had complications related to the surgical procedure, but four patients required postoperative intensive care unit up to two months due to several problems related to NIC. RALNF can be safely applied to pediatric patients with GERD with severe and moderate NIC.