Laparo-Endoscopic Single Site (Less) Fundoplication: Initial Experience with Safety and Reduction of Symptoms
Seaborn a. Roddenbery*, Sharona B. Ross, Connor a. Morton, Michelle Vice, Sujat Dahal, Linda K. Barry, Michelle Hamel, Alexander S. Rosemurgy
Surgery, University of South Florida, Tampa, FL
Introduction: LESS surgery, which began with cholecystectomy, has progressed to complex procedures. The safety and efficacy of LESS fundoplication has not been established. This report details our experience with LESS fundoplication for GERD and provides a comparison to earlier patients undergoing conventional laparoscopic fundoplication.Methods: LESS fundoplications were undertaken via a transumbilical approach; conventional laparoscopic fundoplications were undertaken using five trocars, four of which were distant to the umbilicus. Symptoms before and after fundoplication were scored by patients using a Likert scale (0=never/not bothersome to 10=always/very bothersome). Outcomes after LESS fundoplication are compared with outcomes of a consecutive contiguous group of patients undergoing conventional laparoscopic fundoplication immediately prior to the initiation of LESS fundoplication. Data are presented as median, mean ± SD, where appropriate.Results: Since 2007, 63 patients have undergone LESS fundoplication (56 Nissen, 7 Toupet). Patients undergoing LESS or conventional laparoscopic fundoplication were similar in age, BMI, preoperative DeMeester score, intraoperative blood loss, and length of hospital stay (Table). There were no conversions to “open”; there were no notable perioperative complications. Patients undergoing LESS fundoplications had no apparent scars. Symptom reduction was broad and dramatic, and similar for patients undergoing LESS versus conventional laparoscopic fundoplication. Conclusions: LESS fundoplication is a safe and efficacious therapy for GERD. LESS surgery provides excellent resolution of symptoms without apparent scar. While the LESS approach does prolong the operation, it does not do so notably. In comparison with conventional laparoscopic fundoplication, LESS fundoplication is safe and provides similar satisfactory symptom relief, but without any apparent scar.
| Conventional Laparoscopic Fundoplication | LESS Fundoplication | P- value | |
| Number of Patients: | 63 patients | 63 patients | |
| Gender: | 23 males / 40 females | 18 males / 45 females | NS |
| Age (median): | 54 years | 54 years | NS |
| BMI (median): | 26 kg/m2 | 27 kg/m2 | NS |
| DeMeester Score: | 32 (41 ± 40) | 35 (43 ± 35) | NS |
| Length of Operation: | 90 min | 147 min | p <0.001 |
| Blood Loss: | 58 (<100 cc)5 (200- 500 cc) | 55 (<100 cc)8(100-150 cc) | NS |
| Length of Stay (median): | 1 day | 1 day | NS |
| Heartburn severity: prefundoplication postfundoplication | 7 (6 ± 3.6) 0 (1 ± 2.0)* | 6 (6 ± 3.6) 0 (2 ± 2.7)* | NS NS |
| Regurgitation severity: prefundoplication postfundoplication | 5 (5 ± 3.5) 0 (1 ± 2.5)* | 6 (5 ± 4.0) 0 (1 ± 1.1)* | NS NS |
Data presented as median, with mean ± SD where appropriate * p<0.01, less than before fundoplication, Wilcoxon matched pairs test
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