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Avoiding Technical Pitfalls

Stephen R. T. Evans, MD; Patrick G. Jackson, MD; Donald R. Czerniach, MD; Mohammed M. H. Kalan, MD; Alberto R. Iglesias, MD

Arch Surg. 2000;135:723-728.

Laparoscopic Nissen fundoplication is now widely used in the surgical management of gastroesophageal reflux disease. However, it is a complex operation that requires advanced laparoscopic skills. The learning curve is steep, and complications are directly related to the surgeon's experience level. Both experimental and clinical data demonstrate a decline in complications with increasing experience. We divided this complex procedure into logical and orderly components, to facilitate the learning process. We believe that this approach will not only reduce complications by highlighting potential problems at each stage but also make it easier to teach others.

From the Departments of Surgery, The George Washington University Medical Center, Washington, DC (Drs Evans, Czerniach, Kalan, and Iglesias), and Massachusetts General Hospital, Boston (Dr Jackson).

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