Antireflux surgery in Sweden, 1987-1997: A decade of change

Background: The aim of this study was to analyse whether new therapeutic op tions-the introduction of proton-pump inhibitors (PPI) in 1989 and the lapa roscopic technique in 1992-altered the surgical treatment of gastro-oesopha geal reflux disease (GORD) in Sweden. Methods: Data obtained from the Centr e for Epidemiology (EpC) on patients undergoing surgery for GORD from 1987 to 1997 was analysed, and the information was validated with a questionnair e to all surgical departments. Results: The questionnaire gave a response r ate of 94%, and the figures corresponded well with those obtained from the EpC. In 1987. 456 antireflux procedures were performed. Ten years later thi s figure had increased to 1303. This approximately threefold increase start ed before the introduction of PPI and was even more pronounced during the f ollowing few years. The development of laparoscopic antireflux surgery did not alter this increase. In 1997, 76% of the procedures were performed lapa roscopically. The fundoplication rate rose from 5.5 to 12.7 procedures/100, 000 inhabitants. The rates varied greatly among different counties; 7 of 23 still had a fundoplication rate of less than 10 in 1997. The median number of procedures per hospital in 1997 was 10. Only two departments accomplish ed more than 50 antireflux procedures. Conclusion: Within 5 years the lapar oscopic technique replaced the open procedure as the method of choice. Howe ver, the increase in the frequency of antireflux surgery was apparent even before the introduction of laparoscopy.