Needlescopic fundoplication.
BACKGROUND
Minimally invasive surgery continues to evolve, with an emphasis on developing new techniques and applying new technology to surgical procedures. The purpose of this study was to compare the short-term outcomes of needlescopic fundoplication with those of conventional laparoscopic fundoplication.


METHODS
Between January 1999 and June 2000, 38 needlescopic fundoplications were performed, and the short-term outcomes for these patients were compared with those for a contemporary matched cohort of patients who had undergone a conventional laparoscopic fundoplication.


RESULTS
There was a nonsignificant trend toward decreased operative time (143.4 to 127 min; p = 0.13), blood loss (54.3 to 48 ml; p = 0.30), narcotic requirements (29.5 to 19.5 morphine equivalents; p = 0.32), and length of hospital stay (1.78 to 1.49 days; p = 0.10) in the needlescopic group. There were no significant differences in intraoperative complications (2.6% vs 2.6%; p = 1.0). Two needlescopic cases were converted to laparoscopic cases because of obesity. Postoperatively, there were no significant differences in rates of early dysphagia (7.9% vs 7.9%), bloating (13.2% vs 5.3%; p = 0.43), or other complications (5.3% vs 5.3%) between the groups. There was a significant reduction in mean operative time for needlescopic fundoplication after the first four cases (166 +/- 44 vs 120 +/- 32 min; p = 0.03).


CONCLUSIONS
Needlescopic fundoplication poses no disadvantage, and it offers the added cosmetic benefit of smaller incisions.
Pace
D E
DE
Centre for Minimally Invasive Surgery, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario, Canada M5B 1 W8.
Chiasson
P M
PM
Schlachta
C M
CM
Poulin
E C
EC
Boutros
Y
Y
Mamazza
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D003680:Deglutition Disorders / Q000209:etiology; D019723:Endoscopes; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009339:Needles; D011183:Postoperative Complications / Q000209:etiology; D018570:Risk Assessment; D013997:Time Factors