Effect of laparoscopic failure on outcome of laparoscopic nissen fundoplication: independent review.
OBJECTIVE
This study was undertaken to determine whether conversion or early reoperation contributed significantly to the eventual outcome of laparoscopic Nissen fundoplication.


METHODS
An independent surgeon, blinded to the operative events, administered two general and one system-specific quality of life tools to the first 100 consecutive patients booked for laparoscopic fundoplication in a community hospital, where the open conversion rate was 4 patients/surgeon and the early reoperation rate 1.5 patients/surgeon for the first 20 operations. Patients were also asked about need for medication, dysphagia, satisfaction (analog scale), and whether, if given it to do over, they would opt for surgery again.


RESULTS
Of the original 100 patients, 40 were studied an average of 5 years after surgery: 26 completed laparoscopically and 14 with laparoscopic failure (13 conversions and 1 early reoperation). Patient characteristics in the two groups were similar, except that there were more older patients with more fixed intrathoracic hiatus hernias in the failure group. Among the parameters examined, no statistically significant differences could be detected between laparoscopic and converted patients.


CONCLUSIONS
General and system-specific quality of life, digestive symptoms, need for medication, patient satisfaction, and willingness to have surgery over again are not altered by conversion or reoperation. Thus, surgeons who have adequate laparoscopic skills, experience with open fundoplication, and training in laparoscopic Nissen fundoplication should feel free to add it to their repertoires provided the likelihood of conversion and reoperation secondary to inexperience is understood by the patient.
Voitk
Andrus
A
Department of Surgery, The Scarborough Hospital, Ontario, Canada. minaise@pathcom.com
Yau
Patrick
P
Joffe
Jacobo
J
Alvarez
Carlos
C
Rosenthal
Gary
G
D005260:Female; D018662:Fundoplication / Q000379:methods / Q000592:standards*; D006801:Humans; D010535:Laparoscopy / Q000592:standards*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology; D011788:Quality of Life; D012086:Reoperation / Q000706:statistics & numerical data; D013997:Time Factors; D017211:Treatment Failure