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首页> 外文期刊>Surgical Endoscopy >Learning curve for laparoscopic repair of very large hiatal hernia.
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Learning curve for laparoscopic repair of very large hiatal hernia.

机译：腹腔镜大裂孔疝修补术的学习曲线。

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BACKGROUND: Laparoscopic repair of a large hiatal hernia is technically challenging. A significant learning curve likely exists that has not been studied to date. METHODS: Since 1992, the authors have prospectively collected data for all patients undergoing laparoscopic repair of a very large hiatal hernia (50% or more of the stomach within the chest). Follow-up evaluation was performed after 3 months, then yearly. Visual analog scores were used to assess heartburn and dysphagia. Patients were grouped according to institutional and individual surgeons' experience to determine the impact of any learning curve. The outcome for procedures performed by consultant surgeons was compared with that for trainees. RESULTS: From 1992 to 2008, 415 patients with a 1-year minimum follow-up period were studied. Institutional and individual experience had a significant influence on operation time, conversion to open surgery, and length of hospital stay. However, except for heartburn scores during a 3-month follow-up evaluation of institutional experience (p=0.03), clinical outcomes were not influenced by either an institutional or individual learning curve. Furthermore, in general terms, whether the procedure was performed by a consultant or a supervised trainee had little effect on outcome. CONCLUSIONS: Institutional and individual learning curves had no significant influence on clinical outcomes, although improved experience was reflected in improved operation time, conversion rate, and hospital stay. These outcomes improved over the first 50 institutional cases, and the outcomes for individual surgeons improved for up to 40 cases.
机译：背景：腹腔镜大裂孔疝的修复在技术上具有挑战性。可能存在迄今为止尚未研究的重要学习曲线。方法：自1992年以来，作者前瞻性地收集了所有接受腹腔镜修复非常大的食管裂孔疝（50％或更多的胸部胃）的患者的数据。 3个月后进行随访评估，然后每年进行一次。视觉模拟评分用于评估烧心和吞咽困​​难。根据机构和个人外科医生的经验将患者分组，以确定任何学习曲线的影响。将顾问外科医生执行的程序的结果与受训者的结果进行了比较。结果：从1992年至2008年，对415例患者进行了最少1年的随访。机构和个人经验对手术时间，改用开放手术以及住院时间有重大影响。但是，除了在3个月的机构经验随访评估中的胃灼热分数之外（p = 0.03），临床结局不受机构或个人学习曲线的影响。此外，总的来说，该程序是由顾问还是由受过培训的受训者执行，对结果的影响很小。结论：机构和个人学习曲线对临床结局没有显着影响，尽管改善的经验反映在手术时间，转换率和住院时间的改善上。在前50个机构病例中，这些结果有所改善，而在多达40个病例中，单个外科医生的结果有所改善。

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