Antirefluxchirurgie in Deutschland Ergebnisse einer repräsentativen Umfrage mit Analyse von 2.540 Antirefluxoperationen

INTRODUCTION: Aim of this study was the evaluation of antireflux surgery in Germany. METHODS: An anonymous questionnaire including 288 structured items about diagnostic and therapeutic approaches, complications and mortality was sent to 33% randomly selected German general surgeons (n = 546) at the end of 2000. RESULTS: A total of 2,540 antireflux procedures was reported, 81% were performed laparoscopically; 65% were total, 31% partial fundoplications. The number of surgeons offering laparoscopic antireflux surgery increased from 0.3% in 1990 to 5% in 1995 and to 32% in 2000. Numerous modifications regarding esophageal mobilisation, crural repair, kind and extension of the wrap, use and size of a bougie, as well as an additional gastropexy were observed. Morbidity rates were significantly higher for open than for laparoscopic procedures (15.0% vs. 7.7%), mainly caused by wound healing problems (4.4% vs. 0.8%) and splenic lesions (3.1 vs. 0.6%). Gastric and esophageal perforations were similar in both groups (1.1 vs. 0.9%). Hospital mortality rate was 0.1%. We observed a frequency dependent learning curve regarding complication rates after laparoscopic antireflux surgery (< 11 fundoplication p.a.: 14.0%; 11-30 fundoplications: 7.3% (p = 0.05); > 30 fundoplications: 4.2% (p = 0.05%). Long-term-dysphagia occurred more often after 360 degrees-versus partial fundoplications (6.6% vs. 2.4%; p < 0.001) and after Nissen/Nissen-Rossetti--than after Floppy-Nissen-procedures (6.6% vs. 3.6%, p = 0.1). The recurrency rate was 9.3% without significant differences between the procedures. CONCLUSION: Laparoscopy has replaced the open technique. Different technical approaches significantly affect the outcome after laparoscopic antireflux surgery in Germany.