INCIDENCE OF ANTIREFLUX SURGERY IN FINLAND 1988-1993 - INFLUENCE OF PROTON-PUMP INHIBITORS AND LAPAROSCOPIC TECHNIQUE

Background: The advent of proton-pump inhibitors, and subsequently of the laparoscopic technique, can be assumed to have influenced the use of antireflux surgery in gastro-oesophageal reflux disease. Methods. D ata on antireflux operations carried out in Finland in 1988-93 were ob tained from national statistics, and the number of operations performe d laparoscopically in 1993 was ascertained by a questionnaire to all r elevant units. The rates per 100,000 population in the catchment areas were calculated. Results: Antireflux surgery almost always implied fu ndoplication. During 1993, 784 fundoplications and 43 other antireflux procedures were performed in Finland (total population around 5 milli on). The fundoplication rate per 100,000 population rose from 8.8 to 1 5.4 between 1988 and 1993. The increase was minimal (8.1-8.2) in 1990- 91 when the first proton-pump inhibitor, omeprazole, was introduced, b ut remarkably greater (12.8-15.4) in 1992-93, when the laparoscopic te chnique became popular. Differences in fundoplication rates were six t o tenfold between health service districts and even larger between hos pitals. Conclusions: The numbers of antireflux operations in Finland w ere almost static when proton-pump inhibitors were introduced, but rap idly increased after the advent of the laparoscopic technique. Remarka ble discrepancies were found in the incidence of fundoplication betwee n different areas and hospitals.