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Impact of surgeon experience on 5-year outcome of laparoscopic Nissen fundoplication
- Source :
- Archives of Surgery, 146, 340-6, Archives of Surgery, 146(3), 340-346. American Medical Association, Archives of Surgery, 146, 3, pp. 340-6, ResearcherID, Archives of surgery (Chicago, Ill., 146(3), 340-346. American Medical Association
- Publication Year :
- 2011
-
Abstract
- Item does not contain fulltext OBJECTIVE: To investigate the 5-year effect of surgeon experience with laparoscopic Nissen fundoplication (LNF). In 2000, a randomized controlled trial (RCT) was prematurely terminated because LNF for gastroesophageal reflux disease was associated with a higher risk to develop dysphagia than conventional Nissen fundoplication (CNF). Criticism focused on alleged bias caused by the relative lack of experience with the laparoscopic approach of the participating surgeons. DESIGN: Multicenter RCT and prospective cohort study. SETTING: University medical centers and tertiary teaching hospitals. PATIENTS: In the RCT, 74 patients underwent CNF and 93 patients underwent LNF (LNFI). The complete setup of the cohort study (LNFII) (n = 121) mirrored the RCT, except that surgeon experience increased from more than 5 to more than 30 LNFs per surgeon. INTERVENTIONS: Conventional Nissen fundoplication, LNFI, and LNFII. MAIN OUTCOME MEASURES: Intraoperative and in-hospital characteristics, objective reflux control, and clinical outcome. RESULTS: In LNFII, operating time (110 vs 165 minutes; P < .001), dysphagia (2.5% vs 12.3%; P = .008), dilatations for dysphagia (0.8% vs 7.0%; P = .02), and conversions (3.5% vs 7.7%; P = .19) were reduced compared with LNFI. Moreover, in LNFII, hospitalization (4.2 vs 5.6 days; P = .07 and 4.2 vs 7.6 days; P < .001) and in-hospital complications (5.1% vs 13.5%; P = .046 and 5.1% vs 19.3%; P = .005) were reduced compared with LNFI and CNF, respectively. In LNFII, the 6-month reintervention rate was reduced compared with LNFI (0.8% vs 10.1%; P = .002). Esophagitis and esophageal acid exposure at 3 months and reflux symptoms, proton-pump inhibitor use, and quality of life at 5 years improved similarly. CONCLUSIONS: Operating time, complications, hospitalization, early dysphagia, dilatations for dysphagia, and reintervention rate after LNF improve significantly when surgeon experience increases from more than 5 to more than 30 LNFs. In contrast, short-term objective reflux control and 5-year clinical outcome do not improve with experience. In experienced hands, LNF reduces in-hospital complications and hospitalization compared with CNF, with similar 5-year effectiveness and reoperation rate.
- Subjects :
- Adult
Male
medicine.medical_specialty
Time Factors
Adolescent
medicine.medical_treatment
Fundoplication
Nissen fundoplication
Risk Assessment
law.invention
Young Adult
Postoperative Complications
Randomized controlled trial
law
Recurrence
medicine
Humans
Practice Patterns, Physicians'
Laparoscopy
Prospective cohort study
Aged
Aged, 80 and over
Laparotomy
medicine.diagnostic_test
business.industry
Reflux
Middle Aged
medicine.disease
Dysphagia
Surgery
Treatment Outcome
Evaluation of complex medical interventions [NCEBP 2]
Gastroesophageal Reflux
Female
Clinical Competence
medicine.symptom
business
Esophagitis
Cohort study
Follow-Up Studies
Subjects
Details
- ISSN :
- 00040010
- Volume :
- 146
- Database :
- OpenAIRE
- Journal :
- Archives of Surgery
- Accession number :
- edsair.doi.dedup.....af285865d17f8fe1ee3ec8d238ba3129