title: Good training allows excellent results for laparoscopic Nissen fundoplication even early in the surgeon's experience.
abstract: BACKGROUND
  Laparoscopic antireflux surgery is the gold standard for surgical treatment of gastroesophageal reflux disease (GERD), and a well-defined learning curve for the procedure has been described. This study aimed to assess whether the surgeon's experience has an effect on 1-year symptom scores and patient satisfaction.
  
  
  METHODS
  All the patients who underwent antireflux surgery were entered into a prospectively maintained database including 1-year postoperative symptom scores. The database was queried in June 2008 to identify patients who had been followed up for 1 year. To decrease variability, the patients with a large hiatal hernia (>5 cm), paraesophageal hernia, treatment with partial fundoplication, a required Collis gastroplasty, or treatment with a transthoracic procedure were excluded from the study.
  
  
  RESULTS
  From September 2003 to March 2007, 215 consecutive patients underwent primary antireflux surgery. Of these 215 patients, 158 (93 women with a mean age of 50.9 ± 13.6 years; range, 18-87 years) met the inclusion criteria and were divided into three groups: early group (9/2003-10/2004), mid group (10/2004-12/2005), and late group (12/2005-3/2007). Experience significantly decreased the mean operative time (P < 0.05) and the hospital stay (P < 0.05). Additionally, the number of patients who required reoperative intervention also decreased with experience. There was no difference in the patient-reported symptom scores at 1 year for heartburn (mean, 0.3 ± 0.7), regurgitation (mean, 0.1 ± 0.4), or dysphagia (mean, 0.3 ± 0.6) (P > 0.05 for each). However, chest pain (mean, 0.2 ± 0.4) was significantly improved with experience (P < 0.05). The overall patient-reported mean satisfaction was 9.0 ± 1.9 (P > 0.05, scale, 1-10), and 14.5% (19/131) of the patients reported use of acid suppression medications.
  
  
  CONCLUSIONS
  A high degree of 1-year symptom resolution and satisfaction can be achieved even early in a surgeon's experience provided there is adequate training and maintenance of strict adherence to technique.
authors.affiliation: Department of Surgery, Creighton University Medical Center, 601 North 30th Street, Suite 3700, Omaha, NE 68131, USA.
authors.forename: Kazuto
authors.initials: K
authors.lastname: Tsuboi
authors.forename: Juliana
authors.initials: J
authors.lastname: Gazallo
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Yano
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Filipi
authors.forename: Sumeet K
authors.initials: SK
authors.lastname: Mittal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D018662:Fundoplication / Q000009:adverse effects / Q000193:education*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000193:education*; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D055815:Young Adult
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