Impact of the Number of Board-Certified Pediatric Surgeons per Pediatric Population on the Outcomes of Laparoscopic Fundoplication for Neurologically Impaired Patients.

Background and Aim: The distribution of board-certified pediatric surgeons (BCPSs) in Japan is highly biased. While Prefecture M has one of the smallest numbers of BCPSs per pediatric population, neighboring Prefecture K has one of the largest numbers of BCPSs per pediatric population. We examined the effect of BCPSs population on laparoscopic surgery and postoperative management and outcomes. Materials and Methods: We compared postoperative duration to full-dose enteral nutrition, postoperative hospital stay, and complications of neurologically impaired patients who underwent laparoscopic fundoplication in two prefectures from 2006 to 2019. Results: Laparoscopic fundoplication was performed in 17 patients in Prefecture M and 63 in K . The mean operative time was 248.8 ± 79.9 minutes in Prefecture M and 260.8 ± 94.8 in K ( P  = .64). The median number of days to full-dose enteral nutrition was 11.5 in Prefecture M and 10 in K ( P  = .29). The median postoperative hospital stay was 14 days in Prefecture M and 15 days in K ( P  = .38). Postoperative complications occurred in 7 cases in Prefecture M and in 10 in K . The incidence was significantly higher in Prefecture M than in K ( P  = .041). Conclusion: Areas with insufficient numbers of BCPSs have a higher risk of complications in laparoscopic surgery than areas with sufficient numbers.