title: Minilaparoscopic fundoplication: technical adaptations and initial experience.
abstract: BACKGROUND
  Gastroesophageal reflux disease (GERD) is a highly prevalent disease. Treatment is divided into lifestyle modifications, medical and surgical treatment. Surgical laparoscopy is the gold standard treatment. In the last decade, there were an extensive research on procedures, less aggressive than laparoscopy and with better esthetic results. Minilaparoscopy is "reemerging" as a safe, effective and with excellent cosmetic results in selected patients treated for gastroesophageal reflux disease. We present a serie of 27 patients treated for GERD by minilaparoscopic laparoscopy.
  
  
  METHODS
  Between October 2009 July 2011 a total of 27 patients underwent fundoplication by minilaparoscopy. It is used one 10mm trocar, a telescope of 30 degrees and four 3 mm trocars at regular positions. Regular surgical steps are done with no modifications. Cardiac tape, suture needles, and eventually extracting bag, gauze, are placed and taken out through the umbilical port. With these technical adjustments, we can perform the procedure safely and effectively, similarly to standard laparoscopic technique.
  
  
  RESULTS
  Of the 27 patients, 22 were female and 5 male. The average body mass index was 25.5 kg/m². Hiatal hernias were small (<3 cm) in 24 patients. Mean operative time was 60 minutes. In all cases the hiatoplasty was performed with simple or 'x' stitches of 2.0 Ethibond. There was no need for conversion to standard laparoscopy or open surgery. The length of hospital stay was less than or equal to 24 hours in all patients. In this series of patients there were no postoperative complications. We did not observe any complication of the surgical wound. There were no evidence of recurrence of symptoms or endoscopic changes.
  
  
  CONCLUSIONS
  Hiatoplasty associated with fundoplication using minilaparoscopic instruments is safe, feasible and effective. If compared to other "new access", has a spectacular esthetic results. Can be done with only minor technical adjustments, for any experienced laparoscopic surgeon, and is perfectly adaptable to our financial reality.
authors.affiliation: Minimally Invasive Surgery Department, Jacques Perissat Institute, Positivo University, Curitiba, PR, Brazil. daniellsondimbarre@hotmail.com
authors.forename: Daniellson
authors.initials: D
authors.lastname: Dimbarre
authors.forename: Paula Marcelo
authors.initials: PM
authors.lastname: de Loureiro
authors.forename: Christiano
authors.initials: C
authors.lastname: Claus
authors.forename: Gustavo
authors.initials: G
authors.lastname: Carvalho
authors.forename: Pedro
authors.initials: P
authors.lastname: Trauczynski
authors.forename: Fabiano
authors.initials: F
authors.lastname: Elias
mesh_terms: D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D016896:Treatment Outcome