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Learning curve for laparoscopic repair of very large hiatal hernia

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Abstract

Background

Laparoscopic repair of a large hiatal hernia is technically challenging. A significant learning curve likely exists that has not been studied to date.

Methods

Since 1992, the authors have prospectively collected data for all patients undergoing laparoscopic repair of a very large hiatal hernia (50% or more of the stomach within the chest). Follow-up evaluation was performed after 3 months, then yearly. Visual analog scores were used to assess heartburn and dysphagia. Patients were grouped according to institutional and individual surgeons’ experience to determine the impact of any learning curve. The outcome for procedures performed by consultant surgeons was compared with that for trainees.

Results

From 1992 to 2008, 415 patients with a 1-year minimum follow-up period were studied. Institutional and individual experience had a significant influence on operation time, conversion to open surgery, and length of hospital stay. However, except for heartburn scores during a 3-month follow-up evaluation of institutional experience (p = 0.03), clinical outcomes were not influenced by either an institutional or individual learning curve. Furthermore, in general terms, whether the procedure was performed by a consultant or a supervised trainee had little effect on outcome.

Conclusions

Institutional and individual learning curves had no significant influence on clinical outcomes, although improved experience was reflected in improved operation time, conversion rate, and hospital stay. These outcomes improved over the first 50 institutional cases, and the outcomes for individual surgeons improved for up to 40 cases.

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Acknowledgments

The authors thank all participating surgeons for contributing to the database and Prof. A. Esterman, PhD, for support with the statistical analysis.

Disclosures

Eu Ling Neo, Urs Zingg, Peter G. Devitt, Glyn G. Jamieson, and David I. Watson have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Flinders University Department of Surgery, Flinders Medical Centre, Room 3D211, Bedford Park, SA, 5042, Australia

    Eu Ling Neo & David I. Watson

  2. Discipline of Surgery, University of Adelaide, Adelaide, Australia

    Urs Zingg, Peter G. Devitt & Glyn G. Jamieson

Authors
  1. Eu Ling Neo
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  2. Urs Zingg
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  3. Peter G. Devitt
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  4. Glyn G. Jamieson
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  5. David I. Watson
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Corresponding author

Correspondence to David I. Watson.

Additional information

E. L. Neo and U. Zingg contributed equally.

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Neo, E.L., Zingg, U., Devitt, P.G. et al. Learning curve for laparoscopic repair of very large hiatal hernia. Surg Endosc 25, 1775–1782 (2011). https://doi.org/10.1007/s00464-010-1461-8

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  • DOI: https://doi.org/10.1007/s00464-010-1461-8

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