Laparoscopic antireflux surgery: key to success in the community setting.

Studies from large volume centers of excellence have proven the efficacy of laparoscopic antireflux surgery. However, the majority of these operations are performed in community hospitals, where the results are more variable. Major issues potentially affecting laparoscopic antireflux surgery in community hospitals include a) the individual skills and experience of the surgeons, b) the volume of operations per surgeon and hospital, and c) the sophistication of the esophageal motility labs evaluating these patients prior to surgery. Another evolving issue is the increasing number of fundoplication failures and where best to evaluate and treat these patients.