Robot-Assisted Laparoscope Fundoplication For Gastro-esophageal Reflux Disease: A Systematic Review Of Randomized Controlled Trials

Objective To evaluate the efficacy and safety of robot-assisted fundoplication (RAF) for treating gastroesophageal reflux disease (GERD).Methods We searched PubMed(1966 to 2010), EMBASE (1974 to 2010), the Cochrane Library (issuel,2010), SCI (1974 to 2010), Chinese Biomedical Database (1978 to 2010), China Academic Journals Full-Text Database (1994 to 2010), Chinese Scientific Journals Database (1989 to 2010) and China Online Journals (1997 to 2010), Web information of unpublished trials were searched by hand-searching reference lists and abstracts of conference proceedings and nephrology scientific meetings and Google and MedicalMartix;all randomized controlled trials (RCTs) or quasi-RCTs which described using RAF versus CLF for the treatment of gastroesophageal reflux disease will be included.Two authors extracted information of included trails and assessed quality of included literatures respectively, according to the assessment approaches provided by the Cochrane Handbook version 5.0.2 from the Cochrane Collaboration guidelines and analyzed the data using the Cochrane Collaboration's RevMan 5.0. description analysis will be used in literatures existing heterogeneity.Results A total of 130 studies were identified using the planned search strategy, and 125 articles which did not meet the inclusion criteria were subsequently excluded. A meta-analysis showed that there is different between two groups in the time taken to carry out fundoplication[MD=3.00,95%CI (2.12,3.88), P<0.00001], but there were no different between two groups in postoperative antisecretory medication [OR=1.00,95%CI (0.23,4.29),P=1.0],intraoperative conversion to open surgery[OR=1.05,95%CI (0.23,4.74),P=0.94].postoperative dysphagia[OR=1.00,95%CI (0.36,2.74),P=1.0],pneumothora[OR=1.00,95%CI (0.14,7.33),=1.00], total intraoperative complications[OR=2.33,95%CI(0.40, 13.51),P=0.35],the time of hiatal dissection[MD=-0.10,95%CI (-7.25, 7.06),P=0.98],the time of incision to completion of sutures[MD=-12.21,95% CI (-34.38,9.95),P=0.28]total operation time[MD=22.65,95%CI (-8.68,53.99),P= 0.16],hospital stay[MD=-0.01,95%CI(-0.70,0.67),P= 0.97] and total cost[SMD=6.39,95%CI(-4.61,17.39),P=0.25)]Conclusions The current evidence demonstrates that RAF is safe and effective in treating GERD. The weakness of this treatment method is that it prolongs the time necessary to carry out fundoplication.