Safe transition from open to laparoscopic fundoplication by an established consultant--the importance of repeated audit.
BACKGROUND
Serious complications of laparoscopic fundoplication (LF) have been reported by surgeons new to LF. We investigated whether the reported benefits of LF could be realised by an established consultant, new to LF, without compromising safety, control of reflux or dysphagia rates obtained after open surgery.


METHODS
Outcome of 65 consecutive open fundoplications was audited. After training in LF, this audit was compared with an identical prospective audit of 65 patients undergoing LF.


RESULTS
No significant differences occurred between the two groups in relief of reflux. LF resulted in: (i) shorter postoperative stay (median 2 days versus 7 days, P < 0.001); (ii) earlier return to work (median 4 weeks versus 9 weeks, P < 0.001); (iii) shorter duration of postoperative dysphagia (median 4 weeks versus 9 weeks, P = 0.01); and (iv) less intra/postoperative complications (7.7% versus 32.3%, P < 0.001).


CONCLUSIONS
LF can be introduced safely by established consultants provided that adequacy of training is confirmed by repeated audit.
Tan
L C
LC
Department of Surgery, Poole Hospital, Dorset, UK.
Samanta
S
S
Hosking
S W
SW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000209:etiology*; D005260:Female; D018662:Fundoplication / Q000009:adverse effects / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome