Laparoscopic fundoplication: learning curve and patient satisfaction.
OBJECTIVE
Laparoscopic fundoplication is now accepted as the optimal surgical option for the management of selected cases of gastro-oesophageal reflux disease. The principal aim of this study was to evaluate the learning curve experience of two consultant surgeons in the technique of laparoscopic fundoplication (LF). Additional variables assessed were total number of cases, preoperative investigations, conversion rate, duration of operation, ASA grade, morbidity, mortality, necessity of further procedures, and patient satisfaction rate.


METHODS
Retrospective case-note analysis of all adult patients who underwent fundoplication under the care of two consultant general surgeons over a 3-year period from January 1997 to December 1999.


RESULTS
A total of 61 patients were included, 31 males and 30 females, with a median age of 46 years (range, 21-73 years). Of the patients, 90% were either ASA 1 or 2. The mean time for which the 24-h pH < 4 was 20.5% (95% CI, 15.3-25.7). Of the 61 patients, 6 were operated on by open technique, for medical reasons and previous abdominal procedures. Out of the remaining 55 patients, 13 had to be converted (23.6%). Mean operating times were 120 min for LF, 85 min for open operation and 142 min for LF plus conversion. There was a significant decline in conversion rate with time (P < 0.002). Mortality was nil. One patient had a perforation of the cricopharyngeus secondary to insertion of a bougie. The mean length of hospital stay following the laparoscopic technique was 3.4 days compared to 8.7 days following the open technique. Overall, 59 patients (96%) were happy with the result, and the operation failed in 2 patients. Five patients (8%) needed endoscopic dilatation in the first few weeks after the operation.


CONCLUSIONS
The results show that LF is a safe procedure, takes longer than open procedure, and has an acceptable morbidity. Experience with the technique reduces the need for conversion. The mean length of hospital stay is significantly less and there is a high level of patient satisfaction.
Menon
V S
VS
Department of Surgery, Singleton Hospital, Swansea NHS Trust, Swansea, UK.
Manson
J McK
JM
Baxter
J N
JN
D000328:Adult; D000368:Aged; D002983:Clinical Competence / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000193:education / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007902:Length of Stay; D008297:Male; D008365:Manometry; D008875:Middle Aged; D017060:Patient Satisfaction; D012189:Retrospective Studies