Influence of the learning process on safety and effectiveness of laparoscopic fundoplication

The introduction of laparoscopic techniques into surgical practice has requ ired a learning process on the part of the surgeons involved. The duration, morbidity, and functional outcome of laparoscopic fundoplication were eval uated in our institution's first 146 cases. During a 34-month period the pa tients underwent laparoscopic Nissen (n = 102) or Toupet (n = 44) fundoplic ation. Conversion to open access was necessary in 7 cases, re-operation for complications in 2, all among the first 40 cases of the series. The median operating time was 165 min (range 75-375) in the first 40 cases, and 105 m in (range 50-235) thereafter (P < 0.001). Body mass index, grade of esophag itis, and the surgeon's experience were independent predictors of the opera ting time. One hundred and thirty-four patients (92 %) could be evaluated f or recurrence of reflux, which was encountered in 2 (5 %) of the first 40 c ases and 8 (8 %) of 94 patients in the later group.