Laparoscopic Fundoplication for GORD is a complex procedure

Laparoscopic Antireflux surgery (Nissen Fundoplication) is considered as a routine procedure now. However the technique offered by various surgeons with variable experience results is variable results.

Some surgeons consider this procedure as an intermediate level procedure.

All the experienced upper Gastro intestinal surgeons will strongly disagree with this because this Laproscopic procedure is very complex and has more intricacies than just managing to wrap the fundus of the stomach around the oesophagus. This is feasible to “complete” this operation laparoscopically, however getting excellent results is not always possible.

There are are many areas where an individual surgeon’s expertise can make a huge difference on the results and success of the operation (short and long term) and thus the cost implications to NHS and patient’s benefit from surgery.

One should expect to achieve excellent results in most of the patients. However the initial dyspgaia can be avoided if a surgeon will take fine details like rotation and kinking of the oesophagus with the wrap into account as well. The downward displacement (or inadvertent “placement”!) of the wrap on the stomach is another common error while performing Nissen’s Fundoplication.

The learning curve for this surgery is long. In my own experience having performed this procedure in early nineties it takes more than six to eight years to be comfortable and
competent in achieving consistently good results and this may involve more than a few hundred procedures.

Complex re-do surgery or Giant hiatal hernia surgery requires even bigger numbers and more time to master.

I firmly believe that GORD treatment and its long term results should be assessed for individual surgeons or a group of surgeons who have appropriate expertise in the
procedure as otherwise the overall results will be poorer if many surgeons were grouped together for the reasons of variation in practice and expertise as mentioned above.

Not to forget that now its common to offer this operation to young patients with reasonably good symptom control on medication.

Any long term complication except on very few occasions should not be acceptable.

Reference(s):

https://www.bmj.com/rapid-response/2011/11/02/laparoscopic-fundoplication-gord-complex-procedure

 

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