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James C. Rosser, Jr, MD
New Haven, Conn

Arch Surg. 1999;134:282.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

This article is an excellent overview of the results of the introduction of laparoscopic fundoplication to university and Veterans Affairs academic programs. It is always encouraging to see advanced procedures practiced, taught, and evaluated in these settings. This introduction contrasts sharply with the introduction of laparoscopic cholecystectomy, which was mainly championed by community-based surgical pioneers, while academics were slow to recognize its potential dramatic effect on the practice of surgery. The authors must be commended for their heroic efforts to establish resident proficiency in performing this procedure. Unfortunately, this level of commitment and implementation has not been observed universally.

The article provided answers about the authors' experience as the result of their approach to introducing laparoscopic antireflux procedures into their institution. But the review raises more questions than answers about the learning curve they encountered. First of all, whose learning curve is being assessed, that . . . [Full Text of this Article]

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