title: Surgeons' experience with laparoscopic fundoplication after the early personal experience: does it have an impact on the outcome?
abstract: BACKGROUND
  The adverse outcomes of laparoscopic fundoplication are more likely during the initial 20 cases performed by each individual surgeon. This study aimed to evaluate the impact of substantial surgical experience versus experience beyond the learning curve on the early and late objective and subjective results.
  
  
  METHODS
  The patients were divided into two groups according to the surgeon. In group 1 (n = 230), all the patients underwent surgery by a surgeon with substantial experience in laparoscopic fundoplication. In group 2 (n = 118), the patients were treated by a total of seven surgeons whose personal experience exceeded the individual learning curve, but was distinctively less than that of the group 1 surgeon.
  
  
  RESULTS
  The conversion rate was 2.2% in group 1 and 4.4% in group 2. The median operating time was 65 min in group 1 and 70 min in group 2 (p = 0.0020). The occurrence of immediate complications was 3.5% in group 1 and 7.6% in group 2 (p = 0.0892). At 6 months after surgery, 7.4% of the patients in group 1 and 16.1% of the patients in group 2 reported that dysphagia disturbed their daily lives (p = 0.0115). The late subjective results, including postoperative symptoms and evaluation of the surgical result, were similar in the two groups.
  
  
  CONCLUSIONS
  Substantial experience with the procedure is associated with a shorter operating time and somewhat fewer complications, conversions, and early dysphagia episodes. This supports the provision of expert supervision even after the initial learning phase of 20 individual procedures. The patients' long-term subjective symptomatic outcome was similar in the two groups. Substantial experience does not provide better late results than surgical experience beyond the learning curve.
authors.affiliation: Department of Surgery, Turku University Central Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland. paulina.salminen@tyks.fi
authors.forename: P
authors.initials: P
authors.lastname: Salminen
authors.forename: H
authors.initials: H
authors.lastname: Hiekkanen
authors.forename: S
authors.initials: S
authors.lastname: Laine
authors.forename: J
authors.initials: J
authors.lastname: Ovaska
mesh_terms: D002983:Clinical Competence; D003680:Deglutition Disorders / Q000209:etiology; D018662:Fundoplication / Q000009:adverse effects; D005764:Gastroesophageal Reflux / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D011183:Postoperative Complications