270 Laparo-Endoscopic Single Site (LESS) Fundoplications: Lessons Learned

Abstract

Introduction: Laparo-Endoscopic Single Site (LESS) surgery is a more recent advance in the progression of minimally invasive surgery. This study was undertaken to assess lessons learned after our first 270 LESS fundoplications for gastroesophageal reflux disease (GERD). Methods: All patients undergoing LESS fundoplications were prospectively followed from 2008-2014. Patients scored the frequency/severity of their symptoms before/after LESS fundoplication using a Likert scale (0=never/not bothersome to 10=always/very bothersome). Patients also scored their incision satisfaction using a Likert scale (0=revolting to 10=beautiful). Median data are reported. Results: Of 270 patients, 186 underwent nissen fundoplictions and 84 underwent toupet fundoplications. The median patient was 61 years old with a BMI of 26.7 and a Demeester score of 27. The most common preoperative symptom was heartburn (frequency = 6, severity=7). 14 (5%) patients had postoperative complications, most notably pneumonic pleural effusions (n=2), ileus (n=2), and dysphagia (n=3). Length of stay was 1 day with 52% of patients returned to usual activities by 2 - 4 weeks. Symptoms were ameliorated postoperatively (e.g. heartburn: frequency=0, severity=0, p < 0.01). One month postoperativiely, no patients were using proton pump inhibitors or H2-blockers. At 3 months and at one year, 46% of patients returned to using PPI's and H2—blockers. Postoperatively, patients felt size of scar was most important and scored satisfaction with their incisions as a 10. 85% of patients were satisfied with their overall experience; nearly all would still have the operation knowing what they know now. Conclusion: Patients report significant symptom relief, high satisfaction, and excellent cosmesis after LESS fundoplication. LESS fundoplication safely ameliorates symptoms of GERD with short confinement and pronounced satisfaction, in part because of the cosmetic outcome (i.e. lack of scaring). It's future application is encouraged.