Are Posterior Crural Stitches Necessary in Pediatric Laparoscopic Fundoplication?

Creator(s)

Wendy Jo Svetanoff, Children's Mercy HospitalFollow
Charlene Dekonenko, Children's Mercy Hospital
Kayla B. Briggs, Children's Mercy HospitalFollow
James Fraser, Children's Mercy HospitalFollow
Tolulope A. Oyetunji MD MPH, Children's Mercy HospitalFollow
Shawn D. St Peter, Children's Mercy HospitalFollow

Document Type

Article

Publication Date

12-2020

Identifier

DOI: 10.1089/lap.2020.0646

Abstract

Introduction: Minimal esophageal mobilization during laparoscopic fundoplication decreases the rate of wrap transmigration, and previous study has shown that placement of esophageal-crural sutures does not offer any advantages in preventing wrap migration. Our aim was to determine the need for posterior crural sutures during laparoscopic fundoplication.

Methods: This was a retrospective review of patients >1 month old who underwent a primary laparoscopic fundoplication from 2010 to 2019. Demographic, surgical, and outcome data were recorded. Primary outcome was transmigration of the fundoplication wrap. Analysis was performed using STATA® (StataCorp, College Station, TX); Pvalue

Results: There were 181 patients included. The median age was 7.2 months (interquartile range [IQR] 3.7, 17.0) with 59% being male patients. Sixty-one (34%) patients received posterior crural stitches and 120 (66%) did not receive stitches according to staff preference. The stitch group had a median of 1 (IQR 1, 1) posterior crural stitches placed. There was no difference in the incidence of wrap migration, the number of patients requiring a workup for recurrent symptoms, or reoperation between the two groups (Table 1). A significantly higher percentage of patients in the no-stitch group underwent concurrent procedures; when controlled for this, there was no difference in the median operative time between the groups (P = .18).

Conclusion: The placement of crural sutures, including the posterior crural suture, does not prevent wrap migration and may not be necessary for prevention of wrap herniation in pediatric fundoplication.

Journal Title

Journal of laparoendoscopic & advanced surgical techniques. Part A

Volume

30

Issue

12

First Page

1272

Last Page

1276

Keywords

fundoplication; laparoscopy; pediatrics

Recommended Citation

Svetanoff WJ, Dekonenko C, Briggs KB, Fraser J, Oyetunji TA, St Peter SD. Are Posterior Crural Stitches Necessary in Pediatric Laparoscopic Fundoplication?. J Laparoendosc Adv Surg Tech A. 2020;30(12):1272-1276. doi:10.1089/lap.2020.0646