EARLY EXPERIENCE AND LEARNING-CURVE ASSOCIATED WITH LAPAROSCOPIC NISSEN FUNDOPLICATION

Background: Laparoscopic approach for hiatal hernia repair is relative ly new. Information on the learning curve is limited, Methods: From Ja nuary 1994 to September 1996, 280 patients underwent antireflux surger y at our institution, A laparoscopic repair was attempted in 60 patien ts (21.4%), There were 38 men and 22 women, Median age was 49 years (r ange 21 to 78 years), Indications for operation were gastroesophageal reflux in 59 patients and a large paraesophageal hernia in one, A Niss en fundoplication was performed in all patients; 53 (88.3%) had concom itant hiatal hernia repair. Results: In eight patients (13.3%) the ope ration was converted to an open procedure. Median operative time for t he 52 patients who had laparoscopic repair was 215 minutes (range 104 to 320 minutes), There were no deaths. Complications occurred in five patients (9.6%), Median hospitalization was 2 days (range 1 to 5 days) , Median operative time and median hospitalization were significantly longer in the first 26 patients than in the subsequent 25 patients (24 8 vs 203 minutes and 2 days vs 1 day, respectively; p = 0.03). Seven o f the first 30 patients (23.3%) required laparotomy as compared with t wo of the second 30 (6.7%) (p = 0.07). Follow-up in the 51 patients wh o had laparoscopic fundoplication for reflux was complete in 50 (98.0% ) and ranged from 7 to 38 months (median 13 months), Functional result s were classified as excellent in 34 patients (68.0%), good in 6 (12.0 %), fair in 7 (14.0%), and poor in 3 (6.0%), Three patients were reope rated on for recurrent reflux symptoms at 5, 5, and 11 months, Conclus ions: We conclude that laparoscopic Nissen fundoplication can be perfo rmed safely, The operative time, hospitalization, and conversion rate to laparotomy are higher during the early part of the experience, but all are reduced after the learning curve.