Minimal vs. maximal esophageal dissection and mobilization during laparoscopic fundoplication: long-term follow-up from a prospective, randomized trial.

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PMID: 25598105 DOI: 10.1016/j.jpedsurg.2014.10.015


PURPOSE: We have previously conducted a prospective randomized trial (PRT) comparing circumferential phrenoesophageal dissection and esophageal mobilization (MAX) to minimal dissection/mobilization (MIN). The MIN group had a decreased incidence of postoperative wrap herniation and need for reoperation. This study provides long-term follow-up of the patients from our center who participated in the PRT.

METHODS: Parents of patients in the PRT were queried regarding symptoms, medication use, postoperative complications, and additional procedures. Medical records were reviewed. Student's t-test was used for continuous variables. Fisher's exact and chi-square with Yates correction were used where appropriate.

RESULTS: Of patients from our center, 75.4% MAX and 72.5% MIN patients were contacted. Median time to follow-up was 6.5 years. A rise in the incidence of herniation was noted in both groups (22.7% to 36.5% MAX vs 2.8% to 12.2% MIN). Time to diagnosis of hernia was significantly longer in the MIN group (14.7±9.5 months MAX vs 30.2±23.6 months MIN, P=0.04). There was no significant difference between MIN and MAX group in reflux symptoms or medication use.

CONCLUSION: Long-term follow-up demonstrates an increase in incidence of herniation in both groups. Previously demonstrated higher risk of wrap herniation with maximal esophageal dissection during laparoscopic fundoplication remains supporting original findings.

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Journal of pediatric surgery





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MeSH Keywords

Adult; Aged; Dissection; Esophagus; Female; Follow-Up Studies; Fundoplication; Gastroesophageal Reflux; Health Services Needs and Demand; Hernia, Hiatal; Humans; Laparoscopy; Male; Middle Aged; Postoperative Complications


Reflux; esophagus

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