Although nonacid reflux could be responsible for symptoms, it selleck chemicals llc has been shown to be very uncommon [49]. Moreover, a recent investigation [50] reported that persistent symptoms are neither caused by acid nor by weakly acidic reflux, but rather by abnormal air handling. To investigate weakly acidic or nonacidic reflux-related symptoms, a combined pH-impedance study is needed, but this test is more costly and technically demanding. 5. Conclusions The evaluation of efficacy of LARS as a permanent treatment for GERD definitely depends on determining what should be considered a successful outcome. This study highlights the need to be careful when considering clinical outcomes reported after antireflux surgery. The complexity in capturing data is evident.

Not only symptoms assessment may be considered not appropriate in some studies, but also symptoms scores and outcome variables reported in different studies are dissimilar, making a plea for more uniform symptoms scales and quality of life tools. This would be of utmost importance in the clinical practice, where either gastroenterologists or primary care physicians need to understand that most patients complaining of postoperative symptoms do not have pathologic reflux. Relying on patient’s satisfaction to define a successful surgical outcome may be ambiguous and cannot probably be taken as a precise and reliable index of a successful procedure, yet from this study it can be considered a practical and simple tool, with uniform results.
Laparoscopic cholecystectomy (LC) was first demonstrated by Philippe Mouret in France in 1987 [1].

Since then, LC has become the standard procedure for the treatment of gallstones, cholecystitis, or gallbladder polyps. Traditionally, LC has involved four ports. Many laparoscopic techniques have been developed using this 4-port LC, and it has become possible to perform these techniques safely. Now, having established the safety of LC, our interest focused on reducing the invasiveness and scarring caused by the procedure. Cuesta et al. reported single-incision laparoscopic cholecystectomy (SILC), in which two 5mm ports were introduced through the umbilicus, and a Kirschner wire hook was introduced through the right subcostal area to pull in an upright direction in order to visualize Calot’s triangle [2]. Several surgeons have described performing SILC using three 5mm ports from the umbilicus [3, 4].

Meanwhile, Merchant et al. also performed SILC by inserting a Gelport (Applied Medical, Rancho Santa Margarita, CA, USA) to stretch the umbilical fascia incision for easy access with instruments into the abdominal cavity [5]. Furthermore, a technique involving several transumbilical-placed ports for single-incision Drug_discovery laparoscopic surgery was newly developed, and SILC by means of the ASC Triport (Advanced Surgical Concepts, Wicklow, Ireland) has been described successively [6�C8]. On the other hand, an interesting new instrument named SPIDER (TransEnterix, Inc.