Centers of Surgical Excellence

A very large number of fundoplication procedures currently are being performed in Western societies,with an appreciable rate of subsequent surgical failure, and a strong association between failure rates and degrees of surgical experience. In many regions of Europe, surgical therapy is performed primarily in centers of excellence in which a high degree of surgical experience is concentrated. No such centers have been mandated in the United States, and most surgical procedures for GERD are performed in community hospitals by surgeons with moderate levels of experience. Given the high cost of GERD therapy, particularly among patients with failed therapy for GERD, important cost savings will be realized when centers of excellence are established for initial endo-scopic and surgical anti-reflux therapy.

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