Laparoscopic anti-reflux surgery in New Zealand: A trend towards partial fundoplication

Background: The advent of laparoscopic anti-reflux surgery has generated co nsiderable debate regarding the best technique. The present study was under taken to determine the trends and current technique in laparoscopic anti-re flux surgery in New Zealand. Methods: A confidential nationwide postal survey was sent to all general su rgeons in New Zealand; it was repeated after a month, and followed up with a telephone prompt, if necessary. Results: Of the 146 questionnaires sent out, 126 were returned (response ra te: 86%), and 104 were excluded (no anti-reflux surgery performed (n = 96); surgeon retired (n = 5); paediatric surgeon (n = 3)). The number of operat ions performed by the 22 (16%) adult general surgeons who had performed lap aroscopic anti-reflux surgery increased 4.6 times from 1991 to 1997 (474 op en and 1218 laparoscopic operations). The median number of cases per surgeo n was 30 (range: 5-300). In 1997 there were 208 (60%) total fundoplications (TF) and 135 (40%) partial fundoplications (PF) performed. Variations in t he technique of TF included the Nissen-DeMeester (10 surgeons), the Nissen- Rosetti (nine surgeons), division of short gastric vessels (10 surgeons), a nd routine cruroplasty (14 surgeons). A PF had never been perfomed by six s urgeons, was preferred by six surgeons, and four other surgeons were perfor ming it more often. Variations in the technique of PF included posterior (1 2 surgeons) and anterior (four surgeons) forms. Conclusion: There is significant variation in the technique of laparoscopic anti-reflux surgery in New Zealand. A TF is preferred by 16 surgeons, but there appears to be a trend towards PF among the more experienced surgeons.