Learning curve of laparoscopic Nissen fundoplication for gastro-esophgeal reflux disease

doi:10.3877/cma.j.issn.1674-392X.2021.02.002

Abstract

Abstract:

Objective

Explore the learning curve of laparoscopic Nissen fundoplication (LNF) for gastro-esophageal reflux disease, and evaluate the surgical effect of LNF and differences in different stages.

Methods

Patients (n=36) with LNF were recruited in the study. The cumulative sum analysis (CUSUM) was used to determine the learning curve of LNF for gastro-esophageal reflux disease. The learning curve in different stageswere compared by analyzing the operation time, blood loss, the postoperative recovery time, RDQ score, GLQI score and postoperative complication.

Results

The CUSUM method obtained the maximum turning point of the curve at 19 cases, which divided the learning curve into two stages: learning improvement and mastery. However, the general data of the two stages was not statistically significant (P>0.05). The operation time, blood loss, postoperative gastrointestinal function recovery time, RDQ score and GLQI score at postoperative 6-month were superior in mastery stage than those in learning improvement stage.

Conclusion

Accurate analysis of the learning curve of LNF for gastro-esophageal reflux disease by CUSUM showed that the required number of handling surgical procedure was 19.

Key words: Laparoscopic, Nissen fundoplication, Gastro-esophageal reflux disease, Learning curve

Jun Du, Junsheng Li, Bojian Fei, Liugen Jin, Hui Jiang, Bai Chen, Lifei Xie. Learning curve of laparoscopic Nissen fundoplication for gastro-esophgeal reflux disease[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2021, 15(02): 123-127.

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Figures/Tables 5

References 13

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组别	例数	术中出血量(ml)	手术时间(min)	住院时间(d)	术后胃肠道功能恢复时间(d)
学习提高	19	50.32±18.65	108.9 ± 8.43	9.22±2.15	2.48±0.73
熟练掌握	17	38.66±15.26	96.6±5.46	7.39±2.56	1.59±0.85
P值		0.049 4	<0.001	0.025 8	0.001 8

组别	例数	术中出血量(ml)	手术时间(min)	住院时间(d)	术后胃肠道功能恢复时间(d)
学习提高	19	50.32±18.65	108.9 ± 8.43	9.22±2.15	2.48±0.73
熟练掌握	17	38.66±15.26	96.6±5.46	7.39±2.56	1.59±0.85
P值		0.049 4	<0.001	0.025 8	0.001 8

组别	时间	烧心	胸痛	反酸	反流
学习提高	术前	3.78±0.85	3.63±1.30	3.53±1.17	3.16±0.90
	术后3个月	2.55±1.27	2.45±1.18	2.73±1.05	2.47±1.05
	术后6个月	1.87±0.95	1.92±0.89	1.72±0.99	1.89±1.03
熟练掌握	术前	4.24±0.75	3.53±1.07	3.94±1.09	3.06±0.75
	术后3个月	2.03±0.69^a	1.89±0.74^a	2.11±0.81^a	1.92±0.75^a
	术后6个月	1.15±0.53^abc	1.32±0.55^abc	1.17±0.65^ac	1.05±0.32^abc

组别	时间	烧心	胸痛	反酸	反流
学习提高	术前	3.78±0.85	3.63±1.30	3.53±1.17	3.16±0.90
	术后3个月	2.55±1.27	2.45±1.18	2.73±1.05	2.47±1.05
	术后6个月	1.87±0.95	1.92±0.89	1.72±0.99	1.89±1.03
熟练掌握	术前	4.24±0.75	3.53±1.07	3.94±1.09	3.06±0.75
	术后3个月	2.03±0.69^a	1.89±0.74^a	2.11±0.81^a	1.92±0.75^a
	术后6个月	1.15±0.53^abc	1.32±0.55^abc	1.17±0.65^ac	1.05±0.32^abc

组别	例数	术前	术后3个月	术后6个月
学习提高	19	93.96±12.53	105.72±15.40	115.64±16.42
熟练掌握	17	89.44±15.73	112.47±9.94^a	129.95±8.77^abc
F值		1.576	2.400	3.505
P值		0.351	0.845	0.015

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