Surgeons’ experience with laparoscopic fundoplication after the early personal experience: does it have an impact on the outcome?
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The adverse outcomes of laparoscopic fundoplication are more likely during the initial 20 cases performed by each individual surgeon. This study aimed to evaluate the impact of substantial surgical experience versus experience beyond the learning curve on the early and late objective and subjective results.
The patients were divided into two groups according to the surgeon. In group 1 (n = 230), all the patients underwent surgery by a surgeon with substantial experience in laparoscopic fundoplication. In group 2 (n = 118), the patients were treated by a total of seven surgeons whose personal experience exceeded the individual learning curve, but was distinctively less than that of the group 1 surgeon.
The conversion rate was 2.2% in group 1 and 4.4% in group 2. The median operating time was 65 min in group 1 and 70 min in group 2 (p = 0.0020). The occurrence of immediate complications was 3.5% in group 1 and 7.6% in group 2 (p = 0.0892). At 6 months after surgery, 7.4% of the patients in group 1 and 16.1% of the patients in group 2 reported that dysphagia disturbed their daily lives (p = 0.0115). The late subjective results, including postoperative symptoms and evaluation of the surgical result, were similar in the two groups.
Substantial experience with the procedure is associated with a shorter operating time and somewhat fewer complications, conversions, and early dysphagia episodes. This supports the provision of expert supervision even after the initial learning phase of 20 individual procedures. The patients’ long-term subjective symptomatic outcome was similar in the two groups. Substantial experience does not provide better late results than surgical experience beyond the learning curve.
KeywordsLaparoscopic fundoplication Substantial experience GORD GERD Learning curve Early results Long term results Symptomatic outcome
- 5.Bais JE, Bartelsman JF, Bonjer HJ, Cuesta MA, Go PM, Klinkenberg-Knol EC, van Lanschot JJ, Nadorp JH, Smout AJ, van der Graaf Y, Gooszen HG (2000) Laparoscopic or conventional Nissen fundoplication for gastro-oesophageal reflux disease: randomised clinical trial. The Netherlands Antireflux Surgery Study Group. Lancet 355: 170–174PubMedCrossRefGoogle Scholar
- 8.Barrat C, Cueto Rozon R, Catheline JM, Rizk N, Champault G (2000) The effect of the learning curve and the experience on the technique and the outcome of laparoscopic treatment for gastroesophageal reflux. Chirurgia (Bucur) 95: 325– 333Google Scholar
- 27.Spechler SJ, Lee E, Ahnen D, Goyal RK, Hirano I, Ramirez F, Raufman JP, Sampliner R, Schnell T, Sontag S, Vlahcevic ZR, Young R, Williford W (2001) Long-term outcome of medical and surgical therapies for gastroesophageal reflux disease: follow-up of a randomized controlled trial. JAMA 285: 2331–2338PubMedCrossRefGoogle Scholar