Impact of Surgeon Experience on 5-Year Outcome of Laparoscopic Nissen Fundoplication

Broeders, Joris A.; Draaisma, Werner A.; Jong, Hilda G. Rijnhart-de; Smout, A. J. P. M.; Lanschot, J. J.B. van; Broeders, Ivo A. M. J.; Gooszen, Hein G.

doi:10.1001/archsurg.2011.32

Cited by 24 publications

(15 citation statements)

References 37 publications

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“…Several studies have shown surgical outcomes to be dependent on operator experience. 47 – 52 Although questions have been raised about operator use, quality of the mastectomy skin flaps, and surgical outcomes in breast reconstruction, our study found no association between skin necrosis and the type of mastectomy performed or between necrosis and the attending surgical oncologist or reconstructive surgeon placing and filling the TE (data not shown). Further, there was no association between placement of acelluar dermal matrix and necrosis.…”

Section: Discussioncontrasting

confidence: 51%

Mastectomy Weight and Tissue Expander Volume Predict Necrosis and Increased Costs Associated with Breast Reconstruction

Yalanis

Nag

Georgek

et al. 2015

Plastic and Reconstructive Surgery - Global Open

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Introduction:Impaired vascular perfusion in tissue expander (TE) breast reconstruction leads to mastectomy skin necrosis. We investigated factors and costs associated with skin necrosis in postmastectomy breast reconstruction.Methods:Retrospective review of 169 women with immediate TE placement following mastectomy between May 1, 2009 and May 31, 2013 was performed. Patient demographics, comorbidities, intraoperative, and postoperative outcomes were collected. Logistic regression analysis on individual variables was performed to determine the effects of tissue expander fill volume and mastectomy specimen weight on skin necrosis. Billing data was obtained to determine the financial burden associated with necrosis.Results:This study included 253 breast reconstructions with immediate TE placement from 169 women. Skin necrosis occurred in 20 flaps for 15 patients (8.9%). Patients with hypertension had 8 times higher odds of skin necrosis [odd ratio (OR), 8.10, P < 0.001]. Patients with TE intraoperative fill volumes >300 cm3 had 10 times higher odds of skin necrosis (OR, 10.66, P =0.010). Volumes >400 cm3 had 15 times higher odds of skin necrosis (OR, 15.56, P = 0.002). Mastectomy specimen weight was correlated with skin necrosis. Specimens >500 g had 10 times higher odds of necrosis and specimens >1000 g had 18 times higher odds of necrosis (OR, 10.03 and OR, 18.43; P =0.003 and P <0.001, respectively). Mastectomy skin necrosis was associated with a 50% increased inpatient charge.Conclusion:Mastectomy flap necrosis is associated with HTN, larger TE volumes and mastectomy specimen weights, resulting in increased inpatient charges. Conservative TE volumes should be considered for patients with hypertension and larger mastectomy specimens.

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Section: Discussioncontrasting

confidence: 51%

Mastectomy Weight and Tissue Expander Volume Predict Necrosis and Increased Costs Associated with Breast Reconstruction

Yalanis

Nag

Georgek

et al. 2015

Plastic and Reconstructive Surgery - Global Open

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“…On the other hand, clinical outcomes of symptom resolution and patient satisfaction do not improve with experience [1819]. Consistently, we did not observe a difference in symptomatic outcomes according to surgeon experience.…”

Section: Discussionsupporting

confidence: 78%

Factors predicting outcomes of laparoscopic Nissen fundoplication for gastroesophageal reflux disease: experience at a single institution in Korea

Park

Kim

et al. 2017

Ann Surg Treat Res

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PurposeLaparoscopic fundoplication is considered the standard surgical treatment for gastroesophageal reflux disease (GERD) in Western countries. However, some patients experience poor surgical outcomes with this procedure. The study aimed to identify the predictive factors of the surgical outcomes of laparoscopic Nissen fundoplication for the treatment of Korean GERD patients.MethodsSixty-one patients with GERD were treated using laparoscopic Nissen fundoplication between November 2012 and February 2015. Symptom control rates were compared according to clinical and surgical factors to identify predictive factors of successful surgical outcomes.ResultsThirty-five men and 26 women were enrolled. Preoperatively, typical symptoms were present in 60 patients (98%), while atypical symptoms were present in 40 patients (66%). Postoperatively, typical symptoms were controlled in 51 of 60 patients (85.0%), while atypical symptoms were controlled in 33 of 40 patients (82.5%). Overall, at 6 months postsurgery, 54 (88.5%) reported some resolution of GERD symptoms, with 48 (78.7%) achieving complete control. Patients who exhibited a good response to proton pump inhibitor therapy had a significantly greater rate of complete symptom control (P = 0.035).ConclusionLaparoscopic fundoplication is effective for controlling GERD symptoms. Response to preoperative proton pump inhibitor was a predictor of successful outcome.

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“…In all patients a standardised, floppy 360° LNF of 2.5–3.0 cm was constructed after ligation and division of the short gastric vessels, full mobilisation of the oesophagus and posterior crural repair 31–33. LNF was performed by two surgeons beyond the learning curve for LNF,34 either at the University Medical Center Utrecht (EJH and IAMJB) or the tertiary teaching hospital; Meander Medical Center (IAMJB).…”

Section: Methodsmentioning

confidence: 99%

Effects of anti-reflux surgery on weakly acidic reflux and belching

Broeders

Bredenoord

Hazebroek

et al. 2010

Gut

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General rightsIt is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulationsIf you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: http://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible. ABSTRACTBackground Laparoscopic Nissen fundoplication (LNF) is the most frequently performed operation for gastrooesophageal reflux disease (GORD). However, 12% of the patients have persistent reflux symptoms and 19% develop gas-related symptoms after LNF. Weakly acidic reflux and inability to belch have been alleged to cause these symptoms, respectively. The effect of LNF on weakly acidic reflux and (supra) gastric belching was evaluated.Methods In 31 patients upper gastrointestinal endoscopy, stationary oesophageal manometry and 24-h impedanceepH monitoring off acid secretion inhibiting drugs was performed before and 6 months after primary LNF for GORD that was refractory to proton pump inhibitors. Patients filled out validated questionnaires on GERD-HRQoL before and 3, 6 and 12 months after surgery.

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Impact of Surgeon Experience on 5-Year Outcome of Laparoscopic Nissen Fundoplication

Cited by 24 publications

References 37 publications

Mastectomy Weight and Tissue Expander Volume Predict Necrosis and Increased Costs Associated with Breast Reconstruction

Mastectomy Weight and Tissue Expander Volume Predict Necrosis and Increased Costs Associated with Breast Reconstruction

Factors predicting outcomes of laparoscopic Nissen fundoplication for gastroesophageal reflux disease: experience at a single institution in Korea

Effects of anti-reflux surgery on weakly acidic reflux and belching

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