Use of esophagocrural sutures and minimal esophageal dissection reduces the incidence of postoperative transmigration of laparoscopic Nissen fundoplication wrap.
Document Type
Article
Publication Date
1-1-2007
Identifier
DOI: 10.1016/j.jpedsurg.2006.09.051
Abstract
OBJECTIVES: Herniation of the fundoplication wrap through the esophageal hiatus is a common reason for surgical failure in children who have undergone laparoscopic Nissen fundoplication. Extensive mobilization of the gastroesophageal junction in combination with decreased adhesions after laparoscopy may contribute to the development of this complication. In an attempt to decrease the incidence of wrap migration, we changed our technique to minimal mobilization of the intraabdominal esophagus and to placement of esophageal-crural sutures. In this study, we investigate the impact of these modifications on outcome.
METHODS: A retrospective analysis was performed on all patients undergoing laparoscopic fundoplication by the senior author (GWH) from January 2000 through December 2004. Those undergoing operation with extensive esophageal mobilization and without esophagocrural sutures (January 2000 to March 2002) (group I) were compared with those in whom there was minimal esophageal dissection with placement of these esophagocrural sutures (April 2002 to December 2004) (group II).
RESULTS: Two hundred forty-nine patients underwent laparoscopic Nissen fundoplication during the study period. One hundred thirty patients were in group I, and 119 patients were in group II. The rate of transmigration decreased from 12% in group I to 5% in group II (P = .072). The relative risk of transmigration with extensive esophageal mobilization and without the esophagocrural sutures was 2.29.
CONCLUSIONS: This retrospective study has shown that placement of esophagocrural sutures and minimization of the dissection around the esophagus results in a more than 2-fold reduction in the risk of wrap transmigration after laparoscopic Nissen fundoplication.
Journal Title
Journal of pediatric surgery
Volume
42
Issue
1
First Page
25
Last Page
29
MeSH Keywords
Child, Preschool; Diaphragm; Dissection; Esophagus; Fundoplication; Gastroesophageal Reflux; Humans; Infant; Infant, Newborn; Laparoscopy; Postoperative Complications; Retrospective Studies; Suture Techniques; Treatment Outcome
Keywords
Nissen fundoplication; Suture Techniques; Gastroesophageal Reflux
Recommended Citation
St Peter, S. D., Valusek, P. A., Calkins, C. M., Shew, S. B., Ostlie, D. J., Holcomb, G. W. Use of esophagocrural sutures and minimal esophageal dissection reduces the incidence of postoperative transmigration of laparoscopic Nissen fundoplication wrap. Journal of pediatric surgery 42, 25-29 (2007).
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