Robotic-assisted Fundoplication for Treating Pediatric Gastroesophageal Reflux Disease

In August 2007, ECRI Institute published an Emerging Technology Evidence Report titled Pediatric Applications for Robotic Surgery,which reported evidence from three small studies on various procedures. We performed bibliographic searches to update this report in June 2011 and found that pediatric surgeons are now using da Vinci Surgical Systems to assist in a wide variety of laparoscopic, general, and reconstructive surgical procedures. At that time, ECRI Institute decided to publish reports on the most commonly performed pediatric robotic-assisted procedures (i.e., fundoplication, fundoplication). See the previously published report titled, Pediatric Robotic-assisted Fundoplication to Treat Symptomatic Patients withUretero-Pelvic JunctionObstruction.

Proprietary names: da Vinci Surgical System; da Vinci S Surgical System; da Vinci Si Surgical System; da Vinci Si-e Surgical System; EndoWrist instruments Generic names: robotic surgical system; remote surgical manipulator; robotic telemanipulator system; micromanipulator; console-manipulator devices; surgical robot; telesurgical system; telepresence surgery system

Etiology

Gastroesophageal reflux (GER) refers to "immaturity of lower esophageal sphincter (LES) function, manifested by frequent transient lower esophageal relaxations that results in retrograde flow of gastric contents into the esophagus."1 Frequent LES relaxation can lead to irritation of the esophageal mucosa by gastric acid, and resulting esophagitis can cause further LES dysfunction.2 Also, reflux may be caused by gastric or intestinal motility disorders or by gastric outlet obstruction.2

Complications

GER represents a common physiologic occurrence in the first year of life, and by age three to four months, most infants vomit during at least 1 feeding in a 24-hour period.1 GER is usually temporary and does not cause morbidity.2 However, some infants and children develop reflux-related complications, including the following:1-3

Risk Factors

Children at risk for GER complications include those with the following:2

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