[Antireflux surgery in Germany. Results of a representative survey with analysis of 2,540 antireflux operations].
BACKGROUND
Aim of this study was the evaluation of antireflux surgery in Germany.


METHODS
An anonymous questionnaire including 288 structured items about diagnostic and therapeutic approaches, complications and mortality was sent to 33% randomly selected German general surgeons (n = 546) at the end of 2000.


RESULTS
A total of 2,540 antireflux procedures was reported, 81% were performed laparoscopically; 65% were total, 31% partial fundoplications. The number of surgeons offering laparoscopic antireflux surgery increased from 0.3% in 1990 to 5% in 1995 and to 32% in 2000. Numerous modifications regarding esophageal mobilisation, crural repair, kind and extension of the wrap, use and size of a bougie, as well as an additional gastropexy were observed. Morbidity rates were significantly higher for open than for laparoscopic procedures (15.0% vs. 7.7%), mainly caused by wound healing problems (4.4% vs. 0.8%) and splenic lesions (3.1 vs. 0.6%). Gastric and esophageal perforations were similar in both groups (1.1 vs. 0.9%). Hospital mortality rate was 0.1%. We observed a frequency dependent learning curve regarding complication rates after laparoscopic antireflux surgery (< 11 fundoplication p.a.: 14.0%; 11-30 fundoplications: 7.3% (p = 0.05); > 30 fundoplications: 4.2% (p = 0.05%). Long-term-dysphagia occurred more often after 360 degrees-versus partial fundoplications (6.6% vs. 2.4%; p < 0.001) and after Nissen/Nissen-Rossetti--than after Floppy-Nissen-procedures (6.6% vs. 3.6%, p = 0.1). The recurrency rate was 9.3% without significant differences between the procedures.


CONCLUSIONS
Laparoscopy has replaced the open technique. Different technical approaches significantly affect the outcome after laparoscopic antireflux surgery in Germany.
Hüttl
T P
TP
Chirurgische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Klinikum Grosshadern, Marchioninistrasse 15, 81366 München. thomas.huettl@gch.med.uni-muenchen.de
Hohle
M
M
Meyer
G
G
Schildberg
F W
FW
D002423:Cause of Death; D003625:Data Collection; D018662:Fundoplication / Q000706:statistics & numerical data*; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005858:Germany; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D016896:Treatment Outcome