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National-Based Analysis of Laparoscopic and Open Fundoplications

Tuomo K. Rantanen, MD, PhD; Niku K. J. Oksala, MD, PhD; Anni K. Oksala, MD, PhD; Jarmo A. Salo, MD; Eero I. T. Sihvo, MD, PhD

Arch Surg. 2008;143(4):359-365.

Hypothesis  Longer experience of surgeons has reduced the rate of complications in antireflux surgery.

Design  Comparison of the rate of serious complications between open and laparoscopic fundoplication in Finland at the national level.

Setting  University teaching hospital.

Patients  From January 1, 1992, to December 31, 2001, 10 846 fundoplications were performed in Finland. Of these, 3987 (37%) were open and 6859 (63%) were laparoscopic.

Main Outcome Measures  Administrative databases provided the number of fundoplications, the rate of severe complications, and the mortality. Medical records allowed for evaluation of the nature and cause of severe complications of laparoscopic and open fundoplications.

Results  From January 1, 1992, to December 31, 2001, hospital mortality was significantly lower after laparoscopy (P = .01). In comparable groups, surgical mortality or the overall rate of serious complications did not differ. The rate of serious complications decreased after both open surgery (P = .01) and laparoscopic surgery (P = .03). After laparoscopy, patients made claims for injuries more often (P = .003) and had a higher rate of dysphagia (P < .001). In all of the patients with severe dysphagia or fundic perforations after laparoscopy, the short gastric vessels were not divided. Furthermore, 1 open fundoplication and 22 laparoscopic fundoplications had to have reoperations performed owing to dysphagia, mostly involving technical failure.

Conclusions  At the national level, the first 10-year experience of laparoscopic fundoplication reduced the rate of serious complications. The complications largely were technical failures related to the lack of a standardized surgical technique.

Author Affiliations: Department of Gastroenterology and Alimentary Tract Surgery (Dr Rantanen), Division of Vascular Surgery, Department of Surgery (Dr N. K. J. Oksala), and Research Unit of the Centre of Laboratory (Dr A. K. Oksala), Tampere University Hospital, and Department of Forensic Medicine, School of Medicine, University of Tampere (Dr A. K. Oksala), Tampere, Finland; and Division of General Thoracic and Esophageal Surgery, Department of Cardiothoracic Surgery, Helsinki University Central Hospital, Helsinki, Finland (Drs Salo and Sihvo).

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Complications in Antireflux Surgery: National-Based Analysis of Laparoscopic and Open Fundoplications—Invited Critique
George S. Ferzli
Arch Surg. 2008;143(4):365.
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