title: Transoral incisionless fundoplication: initial experience in patients referred to an integrated academic institution.
abstract: Transoral incisionless fundoplication is a new treatment for patients with gastroesophageal reflux disease. We present our initial experience with 10 patients undergoing this procedure with varying past surgical histories. All procedures were performed under general nasotracheal anesthesia.  RAND-36 and Visual Analog Scale symptom scores were collected at pre and postoperative appointments for a mean of 9.2 months. The mean procedure time was 68 minutes. There were no intraoperative or postoperative complications. Patients with prior pancreaticoduodenectomy had observed reduced  working space due to prior distal gastrectomy and required additional insufflation due to no pyloric resistance to insufflation of the small bowel. The patient with prior fundoplication required additional time and force for fastener penetration of the resultant scar from the partially disrupted  fundoplication. All patients were discharged within 23 hours of the procedure. Throughout the follow-up period, patients reported gradual changes in medication requirements and symptom scores. There were no late complications. Transoral incisionless fundoplication is technically safe in well-selected  patients including those with prior esophageal and gastric surgery.
authors: University of California, Irvine Medical Center, Orange, California 92868, USA.
authors: Allan
authors: A
authors: Nguyen
authors: Thomas
authors: T
authors: Vo
authors: Xuan-Mai T
authors: XM
authors: Nguyen
authors: Brian R
authors: BR
authors: Smith
authors: Kevin M
authors: KM
authors: Reavis
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D002140:California; D004947:Esophagus / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009055:Mouth; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D011312:Pressure; D011788:Quality of Life; D012017:Referral and Consultation; D012189:Retrospective Studies; D016896:Treatment Outcome