Please use this identifier to cite or link to this item: https://hdl.handle.net/2440/10111
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Type: Journal article
Title: Laparoscopic surgery for gastro-oesophageal reflux: Beyond the learning curve
Author: Watson, D.
Jamieson, G.
Baigrie, R.
Mathew, G.
Game, P.
Devitt, P.
Britten-Jones, R.
Citation: British Journal of Surgery, 1996; 83(9):1284-1287
Publisher: BLACKWELL SCIENCE LTD
Issue Date: 1996
ISSN: 0007-1323
1365-2168
Abstract: From September 1991 to October 1995, 320 Nissen fundoplications were undertaken laparoscopically by 12 surgeons at a single institution. To assess the performance of the procedure in the hands of five 'experienced' surgeons, the first 20 procedures performed by each surgeon or surgical trainee were excluded, providing a group of 174 patients for review. A short loose 360 degrees fundoplication was performed in all instances, with short gastric vessel division performed in 35.0 per cent of patients and hiatal repair in 66.7 per cent. Median operating time was 80 (range 30-210) min and median postoperative stay was 3 (range 1-19) days. Sixteen procedures (9.2 per cent) could not be completed laparoscopically and required conversion to open surgery. Some 144 patients were reviewed by a scientific officer 3 months after surgery, 85 at 12 months, and 32 at 2 years, using a standard clinical questionnaire. All but one were free from reflux symptoms, although 20.1 per cent reported some dysphagia at 3 months' follow-up; this figure declined to 11 per cent at 12 months and 6 per cent (two of 34 patients) at 2 years. At each follow-up interval, 91 per cent of patients were satisfied with the outcome of the surgery. Objective testing with oesophageal motility (75 patients) and barium swallow (113) studies 3-6 months after surgery confirmed the clinical outcome. Complications occurred in nine patients (5.2 per cent); four (2.3 per cent) of these required a subsequent operation within 30 days of surgery for bleeding (one patient), paraoesophageal herniation (one) and dysphagia (two). A further procedure was necessary in six other patients (3.4 per cent) for late problems, including paraoesophageal herniation (two), hiatal stenosis (three) and gastric obstruction (one). Revision was performed laparoscopically in two patients. The clinical results of laparoscopic Nissen fundoplication by 'experienced' laparoscopic surgeons were comparable with those of open surgery.
Keywords: Humans
Gastroesophageal Reflux
Barium
Laparoscopy
Treatment Outcome
Postoperative Care
Fundoplication
Follow-Up Studies
Gastrointestinal Motility
Clinical Competence
Adolescent
Adult
Aged
Aged, 80 and over
Middle Aged
Patient Satisfaction
Female
Male
DOI: 10.1002/bjs.1800830933
Published version: http://dx.doi.org/10.1002/bjs.1800830933
Appears in Collections:Aurora harvest 2
Surgery publications

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