Robotic surgery for the treatment of achalasia

• Published in: Cirugia española (English ed.) 2022-07, Vol.100 (7), p.410-415
• Main Authors: Alberich Prats, Marta, Bettonica Larrañaga, Carla, Miró Martín, Mónica, Aranda Danso, Humberto, Estremiana García, Fernando, Farran Teixidor, Leandre
• Format: Article
• Language: English
• Subjects: Acalasia; Achalasia; Cirugía robótica; Fundoplication; Funduplicatura; Heller myotomy; Miotomía de Heller; Robotic surgery
• ISSN: 2173-5077; 2173-5077
• DOI: 10.1016/j.cireng.2022.04.023

[Display omitted] To describe the experience of the robotic approach for achalasia surgery in a tertiary center. Patients with achalasia who underwent robotic surgery between May 2010 and April 2019 were analyzed. The study variables were collected in a prospective database and a descriptive analysis was performed. 45 patients (55.6% male) with a mean age of 44 years were included. The main symptom at diagnosis was dysphagia. 19 patients (42.2%) received endoscopic treatment prior to surgery, mostly pneumatic dilation (84.2%). Heller's myotomy associated with Toupet fundoplication was the surgical technique of choice, with a mean operative time of 211 min. The average stay was 5 days. There were 2 postoperative perforations (4.4%). Perioperative mortality was 0%. The mean follow-up was 64 months. At 3 and 5 years, a significant decrease in the Eckardt score was observed and the manometric study showed a decrease in the lower esophageal sphincter pressure at rest of 58% and 70%, respectively, with persistence of hypomotility of the esophageal body. Pathological gastroesophageal reflux was diagnosed in two patients (5.4%) and 4 (10.8%) presented recurrence of symptoms, requiring endoscopic pneumatic dilations. In 2 cases, the dilations were not effective, so an endoscopic myotomy was considered. In our experience, robotic surgery is a safe and effective procedure for the treatment of achalasia. Describir la experiencia del abordaje robótico en la cirugía de la acalasia en un centro de tercer nivel. Se analizaron los pacientes con acalasia intervenidos mediante cirugía robótica entre mayo de 2010 y abril de 2019. Las variables a estudio se recogieron en una base de datos prospectiva y se realizó un análisis descriptivo. Se incluyeron 45 pacientes (55.6% varones) con edad media de 44 años. El síntoma principal al diagnóstico fue la disfagia. 19 pacientes (42.2%) habían recibido tratamiento endoscópico previo a la cirugía, mayoritariamente dilatación neumática (84.2%). La técnica quirúrgica empleada fue la miotomía de Heller asociada a funduplicatura tipo Toupet, con un tiempo operatorio medio de 211 minutos. La estancia media fue 5 días. Se produjeron 2 perforaciones postoperatorias (4.4%). La mortalidad peroperatoria fue del 0%. El seguimiento medio fue de 64 meses. A 3 y 5 años se evidenció una importante disminución del Eckardt score y el estudio manométrico mostró una disminución de la presión del esfínter esofágico inferior en reposo media del 58% y del 7