Incidence of antireflux surgery in Finland 1988-1993. Influence of proton-pump inhibitors and laparoscopic technique.
BACKGROUND
The advent of proton-pump inhibitors, and subsequently of the laparoscopic technique, can be assumed to have influenced the use of antireflux surgery in gastro-oesophageal reflux disease.


METHODS
Data on antireflux operations carried out in Finland in 1988-93 were obtained from national statistics, and the number of operations performed laparoscopically in 1993 was ascertained by a questionnaire to all relevant units. The rates per 100,000 population in the catchment areas were calculated.


RESULTS
Antireflux surgery almost always implied fundoplication. During 1993, 784 fundoplications and 43 other antireflux procedures were performed in Finland (total population around 5 million). The fundoplication rate per 100,000 population rose from 8.8 to 15.4 between 1988 and 1993. The increase was minimal (8.1-8.2) in 1990-91 when the first proton-pump inhibitor, omeprazole, was introduced, but remarkably greater (12.8-15.4) in 1992-93, when the laparoscopic technique became popular. Differences in fundoplication rates were six to tenfold between health service districts and even larger between hospitals.


CONCLUSIONS
The numbers of antireflux operations in Finland were almost static when proton-pump inhibitors were introduced, but rapidly increased after the advent of the laparoscopic technique. Remarkable discrepancies were found in the incidence of fundoplication between different areas and hospitals.
Viljakka
M
M
School of Medicine, University of Tampere, Finland.
Luostarinen
M
M
Isolauri
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D005260:Female; D005387:Finland / Q000453:epidemiology; D018662:Fundoplication / Q000379:methods / Q000592:standards; D005764:Gastroesophageal Reflux / Q000453:epidemiology* / Q000601:surgery; D006761:Hospitals; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000401:mortality; D054328:Proton Pump Inhibitors; D012189:Retrospective Studies; D012621:Seasons; D011795:Surveys and Questionnaires; D015996:Survival Rate
D004791:Enzyme Inhibitors; D054328:Proton Pump Inhibitors; D009853:Omeprazole