title: An "all 5 mm ports" technique for laparoscopic day-case anti-reflux surgery: A consecutive case series of 205 patients.
abstract: Laparoscopic anti-reflux surgery is conventionally performed using two 10/12 mm ports. While laparoscopic procedures reduce post-operative pain, the use of larger ports invariably increases discomfort and affects cosmesis. We describe a new all 5 mm ports technique for laparoscopic anti-reflux surgery and present a review of our initial experience with this approach.
  
  
  
  All patients undergoing laparoscopic fundoplication over a 35 month period from February 2013 under the care of a single surgeon were included. A Lind laparoscopic fundoplication was performed using an all 5 mm port technique. Data was recorded prospectively on patient demographics, operating surgeon, surgical time, date of discharge, readmissions, complications, need for re-intervention, and reasons for admission.
  
  
  
  Two hundred and five consecutive patients underwent laparoscopic fundoplication over the study period. The all 5 mm port technique was used in all cases, with conversion to a 12 mm port only once (0.49%). Median operating time was 52 min 185 (90.2%) patients were discharged as day cases. Increasing ASA grade and the presence of a hiatus hernia were associated with the need for overnight stay with admission required in 33% of patients with ASA 3, compared to 4% with ASA 1 (p = 0.001), and 29% of those with a hiatus hernia vs. 5% without (p < 0.001). No port-related complications occurred, and no patients developed recurrence of reflux symptoms. A single patient required mesh repair of a large hiatus hernia.
  
  
  
  The all 5 mm ports approach to laparoscopic anti-reflux surgery is a safe, efficient, and cost-effective technique which facilitates same day discharge and minimises port related complications. National commissioning guidelines in the UK should target quality improvements in anti-reflux surgery based around day-case management. This would improve the service for these patients and culminate in cost savings for the NHS.
authors.affiliation: Department of Upper Gastrointestinal Surgery, Heart of England NHS Foundation Trust, United Kingdom. Electronic address: mxa891@hotmail.com.
authors.forename: L M
authors.initials: LM
authors.lastname: Almond
authors.affiliation: Department of Upper Gastrointestinal Surgery, Heart of England NHS Foundation Trust, United Kingdom.
authors.forename: V
authors.initials: V
authors.lastname: Charalampakis
authors.affiliation: Department of Upper Gastrointestinal Surgery, Heart of England NHS Foundation Trust, United Kingdom.
authors.forename: P
authors.initials: P
authors.lastname: Mistry
authors.forename: M
authors.initials: M
authors.lastname: Naqvi
authors.affiliation: Department of Medical Statistics, University of Birmingham, United Kingdom.
authors.forename: J
authors.initials: J
authors.lastname: Hodson
authors.affiliation: Department of Upper Gastrointestinal Surgery, Heart of England NHS Foundation Trust, United Kingdom.
authors.forename: G
authors.initials: G
authors.lastname: Lafaurie
authors.affiliation: Department of Upper Gastrointestinal Surgery, Heart of England NHS Foundation Trust, United Kingdom.
authors.forename: J
authors.initials: J
authors.lastname: Matthews
authors.affiliation: Department of Upper Gastrointestinal Surgery, Heart of England NHS Foundation Trust, United Kingdom.
authors.forename: R
authors.initials: R
authors.lastname: Singhal
authors.affiliation: Department of Upper Gastrointestinal Surgery, Heart of England NHS Foundation Trust, United Kingdom.
authors.forename: P
authors.initials: P
authors.lastname: Super
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures; D005260:Female; D018662:Fundoplication / Q000295:instrumentation / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000601:surgery*; D006551:Hernia, Hiatal / Q000150:complications / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation* / Q000379:methods; D008297:Male; D008875:Middle Aged; D013526:Surgical Mesh; D055815:Young Adult
keywords: Anti-reflux surgery; Gastro-oesophageal reflux disease; Laparoscopic fundoplication; Port-site complications