Surgical experience improves the long-term results of Nissen fundoplication.
BACKGROUND
Nissen fundoplication relieves symptoms of gastro-oesophageal reflux and effectively heals oesophagitis. During long-term follow-up some cases of recurrent reflux are seen. We investigated the possibility that long-term cure of gastro-oesophageal reflux after fundoplication is influenced by the surgeon's experience and focused interest, in line with results of surgery for rectal, gastric, and breast cancer.


METHODS
One hundred and five consecutive patients were evaluated a median of 77 months after open Nissen-Rossetti fundoplication for erosive oesophagitis. Follow-up included personal interviews and upper gastrointestinal endoscopy by an investigator not previously involved in the patients' treatment. The surgeons were classified as experienced (>10 of the operations in the series), less experienced (<10 operations), or trainees.


RESULTS
Of the most experienced surgeons' patients, 97% had no or at most mild reflux symptoms at follow-up, compared with 88% of the of less experienced surgeons' patients (P = 0.04). Healing of erosive oesophagitis was commoner when the operations were performed by experienced specialist surgeons (88% versus 72%; P = 0.04). The reoperation rate fell as the surgeons' experience increased, from 12% to 4%.


CONCLUSIONS
Surgery for gastro-oesophageal reflux should be centralized to units specializing in the techniques and with sufficient annual numbers of operations to optimize results. This policy becomes especially advisable as laparoscopic surgery increases the numbers of treated patients.
Luostarinen
M E
ME
Dept. of Surgery, Medical School, University of Tampere, and Tampere University Hospital, Finland.
Isolauri
J O
JO
D002983:Clinical Competence; D004941:Esophagitis / Q000601:surgery*; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D012008:Recurrence; D012086:Reoperation; D016896:Treatment Outcome