Complications in Antireflux Surgery: National-Based Analysis of Laparoscopic and Open Fundoplications

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 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.