HJBR Nov/Dec 2024

58 NOV / DEC 2024 I  HEALTHCARE JOURNAL OF BATON ROUGE SURGERY COLUMN SURGERY GASTROESOPHAGEALREFLUXDISEASE (GERD) is characterized by the reflux of gastric contents into the esophagus, leading to symptoms such as heartburn, regurgitation, and potential complications like esophagitis, Barrett’s esophagus, and esophageal adenocarcinoma. For patients whose symptoms are not adequately managed with lifestyle modifications and pharmacological interventions, such as proton pump inhibitors (PPIs), surgical intervention becomes a key consideration. GERD affects approximately 20% of adults in the United States. Robotic-assisted surgery offers an advanced alternative to traditional laparoscopic techniques in the surgical management of GERD. PATHOPHYSIOLOGY Most, but not all, patients with GERD have an associated hiatal hernia. There are three components of the esophagogastric (EG) junction anti-reflux barrier — the gastroesophageal flap valve with the angle of His, the sling fibers of the lower esophageal sphincter, and the crural diaphragm. Surgical correction typically includes repair of any hiatal hernia defect as well as recreation of a flap valve at the EG junction. Brent W. Allain Jr., MD Bariatric and General Surgeon Our Lady of the Lake Robotic Surgery Institute INDICATIONS FOR SURGICAL INTERVENTION IN GERD The primary surgical treatment for GERD is fundoplication, either a full wrap (i.e., Nissen) or partial fundoplication, de- pendent on patient factors. Other surgical options include magnetic sphincter aug- mentation of the lower esophageal sphinc- ter (LINX procedure) and transoral inci- sionless fundoplication (TIF). For obese patients with GERD, or patients with re- current hiatal hernia and GERD following prior fundoplication, a Roux-en-Y gastric bypass may be indicated. Indications for surgery typically include: • Inadequate response to medical ther- apy: Patients who continue to expe- rience symptoms despite maximum medical management. • Complications of GERD: Including erosive esophagitis, Barrett’s esopha- gus, or strictures. • Patient preference: Some patients opt for surgery to avoid long-term phar- macotherapy. • Extra-esophageal manifestations: Conditions such as asthma, chronic cough, or laryngitis that may be asso- ciated with GERD but remain refrac- tory to medical therapy. ROBOTIC SURGERY IN GERD: AN OVERVIEW Robotic surgery allows for greater pre- cision, flexibility, and control than stan- dard laparoscopic procedures. For GERD, robotic surgery most often applies to ro- botic-assisted fundoplication and robot- ic-assisted hiatal hernia repair. The da Vinci surgical system is the most commonly used robotic platform for these procedures. Key components of robotic surgery include: • Enhanced 3D visualization: The sur- geon operates with a three-dimen- sional, high-definition view, improv- ing depth perception and anatomical clarity. • Greater dexterity: Robotic instru- ments can articulate in ways that hu- man hands or traditional laparoscop- ic instruments cannot, allowing for more precise movements. • Increased stability: Tremor filtration and stable instrument positioning contribute to reduced operator fa- tigue and more consistent perfor- mance. THE ROLE OF ROBOTIC- ASSISTED FUNDOPLICATION The standard surgical treatment for Robotic Surgery in the Treatment of GERD: A GUIDE FOR MEDICAL PROFESSIONALS