Is there a place for laparoscopic antireflux surgery in The Netherlands?

BACKGROUND: Antireflux surgery has not gained wide acceptance in The Netherlands in the past two decades. The introduction of laparoscopic fundoplication seems to have had no impact on the number of antireflux operations performed per year. METHODS: The SIG data were consulted in order to compile an inventory on the number of antireflux operations performed in The Netherlands between 1977 and 1995. The data were compared with those kindly supplied by the Laparoscopic Societies of the Scandinavian countries. RESULTS: The number of antireflux operations per year in The Netherlands, 1.7/100,000 per year, is far less than reported in the four Scandinavian countries, 15/100,000 per year, and also far below the 10/100,000 per year needed for antireflux surgery on a yearly basis. CONCLUSIONS: In The Netherlands, 1.7/100,000 inhabitants per year undergo antireflux surgery. This figure has remained virtually stable in the past two decades, i.e. it has not changed even since the introduction of H2-receptor antagonists, proton-pump inhibitors and laparoscopic antireflux surgery. The success of medical treatment and personal, anecdotal, experience of gastroenterologists with patients they have referred for surgery explain the low number of antireflux operations performed. Currently, a randomized trial is being conducted in The Netherlands comparing the effectivity, costs and quality of life after conventional Nissen fundoplication with the laparoscopic approach. All operations are performed or supervised by a limited number of experienced surgeons who have gone through the learning curve of both the open and conventional technique.