title: A single institution's experience and journey with over 1000 laparoscopic fundoplications for gastroesophageal reflux disease.
abstract: There have been great advances in laparoscopic surgery for gastroesophageal reflux disease (GERD), including laparoendoscopic single-site (LESS) surgery. This study details our experience with over 1000 patients undergoing fundoplication for GERD and the journey therein. A total of  1078 patients have been prospectively followed after fundoplication. Patients scored the frequency/severity of symptoms using a Likert scale (0 = never/not bothersome to 10 = always/very bothersome). We compared the outcomes of the first and last 100 patients. Median data are reported. Of  1078 patients, 943 underwent conventional laparoscopic fundoplication and 135, most recently, underwent LESS fundoplication. Before fundoplication, patients noted frequent/severe symptoms (e.g., heartburn: frequency = 8, severity = 8). Fundoplication ameliorated frequency/severity of symptoms  (e.g., heartburn: frequency = 2, severity = 0; less than preoperatively, P < 0.05). Relative to our first 100 patients, patients after LESS surgery had similar symptom control (e.g., heartburn: frequency = eight to two vs eight to zero, severity = eight to one vs six  to one) but had shorter hospital stays (2 vs 1 day, P < 0.05) and had no apparent scars. Laparoscopic fundoplication provides durable and efficacious treatment for GERD; long-term symptom resolution and patient satisfaction support its continued application. The advent of  LESS surgery advances surgeons' abilities to provide safe and salutary care while promoting cosmesis.
authors.affiliation: Department of Surgery, Tampa General Hospital, Tampa, FL, USA. arosemurgy@tgh.com
authors.forename: Alexander
authors.initials: A
authors.lastname: Rosemurgy
authors.forename: Harold
authors.initials: H
authors.lastname: Paul
authors.forename: Lauren
authors.initials: L
authors.lastname: Madison
authors.forename: Kenneth
authors.initials: K
authors.lastname: Luberice
authors.forename: Natalie
authors.initials: N
authors.lastname: Donn
authors.forename: Michelle
authors.initials: M
authors.lastname: Vice
authors.forename: Jonathan
authors.initials: J
authors.lastname: Hernandez
authors.forename: Sharona B
authors.initials: SB
authors.lastname: Ross
mesh_terms: D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric