gms | German Medical Science

Introduction: Laparoscopic fundoplication has become routine in the surgical management of gastroesophageal reflux disease. New developments in minimally invasive procedures aim at reducing the surgical trauma. In contrast to endoscopic transoral concepts, the new “scarless” transumbilical route allows to respect all technical needs of intrathoracic and intraabdominal steps. Herein we describe our technique

Materials and methods: Between 09-2008 and 01-2010 we performed laparoscopic single port fundoplications solely through a single trocar placed in the umbilicus in six female patients. After giving informed written consent for the modified technique patients (Median/Range age 49/10-64a, BMI 29/19-34kg/m²) were operated in the French position. Procedural steps were identical to conventional laparoscopic fundoplication. Standard instrumentation comprised one articulating grasper, LigaSureV^™, and SILS-Stitch^™. For liver retraction suspension sutures at the beginning and, later, endo-sail ^TMwere utilized. Procedures were video-documented and data collected in a data-base and analysed by means of descriptive statistics

Results: All but the very first procedure could be completed without adding any additional trocar. In one patient two additional 5mm trocars were used to ensure exact suturing of the gastric neo-valve without the help of a SILS-Stitch^™. Total operating time lasted in Median/Range 175/113-218min. Most time was spent for liver retraction and intrathoracic esophageal dissection. Reconstruction was carried out according to the Nissen, Toupet and Dor technique in three, two and one patients, respectively. Blood loss was neglectable in all patients. No intraoperative complication occurred. One patient suffered from pneumonia postoperatively. All patients resumed oral diet after contrast swallows without pathological findings on postoperative day1. Prolonged dysphagia was evident in the first patient.

Conclusion: Laparoscopic transumbilical single port fundoplication is demanding but feasible. This procedure requires high grade experience in standard and single port laparoscopy. New developments in instrumentation will alleviate technical hurdles in the near future.