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Título

Robotic redo antireflux surgery and hiatal hernia repair with bovine pericardium

Resumo

We present a robotic redo antireflux surgery (ARS) and hiatal hernia repair with bovine pericardium performed on a 58-year-old-male for recurrent gastroesophageal reflux disease (GERD) symptoms and new onset dysphagia. He had undergone laparoscopic Nissen ARS and remained asymptomatic for four years. Adequate preoperative work up was done identifying anti-reflux valve herniated with partial disrupted wrap and giant hiatal hernia. After intense adhesiolysis, the herniated viscera were reduced, and the previous valve was takedown. A large hiatal defect was identified requiring anterior and posterior hiatoplasty associated with mesh cruroplasty for reinforcement. The patient had good recovery and remained with no complaints at one year follow-up. Redo ARS is recognized as a more demanding surgery due to dense adhesions and variable anatomy, complicating the localisation of the correct planes for dissection, leading to high hollow visceral perforation and high conversion rates. The challenge increases after the second redo procedure. Robotic assisted surgery in this setting can improve technical skills and has already been associated with minimal morbidity, lower conversion rates and shorter length stay at redo ARS.