Factors Contributing to Laparoscopic Failure during the Learning Curve for Laparoscopic Nissen Fundoplication in a Community Hospital

作者：ANDRUS J. VOITK, Jacobo Joffe, Carlos Álvarez-Fernández, Gary J. Rosenthal · 发表于：Journal of Laparoendoscopic & Advanced Surgical Techniques · 年份：1999 · DOI：10.1089/lap.1999.9.243 · 被引用次数：48 · 研究领域：Esophageal and GI Pathology、Gastroesophageal reflux and treatments、Dysphagia Assessment and Management

This study was done to determine the factors contributing to laparoscopic failure (conversion to open surgery or early reoperation) during the learning curve for laparoscopic Nissen fundoplication in a 228-bed nonteaching community hospital. Data were gathered prospectively for the first 100 consecutive patients booked for elective laparoscopic Nissen fundoplication by the four general surgeons at the hospital. All complications were recorded contemporaneously, and particular note was taken of the factors surrounding conversion to open surgery and reoperation within 100 days of surgery. There were no deaths. The conversion rate was 20% and the early reoperation rate 6%. There were two late recurrences. The average operative time was 117 minutes and the average length of stay 1.8 days; 37 operations were performed on outpatients. The laparoscopic failure rate was 26% (18/68) during a surgeon's first 20 operations and 11% (3/28) thereafter (P < 0.09); the corresponding conversion rates were 22% and 4% (P < 0.05). During a surgeon's first 20 operations, the laparoscopic failure rate rose from 21% (12/57) to 55% (6/11) (P < 0.04) if a second surgeon did not assist. After 20 operations, this difference lost its significance. Intrathoracic herniation of the stomach was found preoperatively in 11 (44%) of 25 operations followed by laparoscopic failure and (8%) 6 of 75 without (P < 0.0002). Laparoscopic failure had no correlation with patient age, sex, ASA classification, duration of...