Laparoscopic antireflux surgery in routine hospital care

The frequency of antireflux surgery has tripled since laparoscopic techniques were introduced. In Sweden, laparoscopic antireflux surgery is often done at local hospitals with a very low annual number of patients. Many surgeons. who may have limited experience with conventional antireflux surgery, have started to perform laparoscopic antireflux procedures, in spite of the well-known fact that there is a long learning curve for laparoscopic antireflux surgery.

A random sample of 225 of 660 patients operated on at high-volume and all 220 patients from low-volume hospitals were identified through a nation-wide register. Outcome 4 years after laparoscopic antireflux surgery was studied using a disease-specific questionnaire.

Treatment failures were more common in the high-volume group than among patients operated on at low-volume hospitals, 29.0% and 19.7%, respectively. In the high volume group, medication (specifically to relieve heartburn or acid regurgitation) was taken at least once a week and revisional surgery was found in 19.5% and 6.0%, respectively. Corresponding results in the low-volume group were 11.1% and 2.9%, respectively. None of these differences was statistically significant at the overall 0.05 level.

A failure rate of almost 30% at 4 years' follow-up for patients operated on at relatively high-volume hospitals was disappointing, despite the fact that these results are population-based. Hospitals are encouraged to provide accounts of their results in an effort to identify the reasons for treatment failures, and for the public to have access to more objective information on different therapeutic options.