Use of esophagocrural sutures and minimal esophageal dissection reduces the incidence of postoperative transmigration of laparoscopic Nissen fundoplication wrap

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 lap...

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Bibliographic Details
Published in:Journal of pediatric surgery 2007-01, Vol.42 (1), p.25-30
Main Authors: St Peter, Shawn D, Valusek, Patricia A, Calkins, Casey M, Shew, Steven B, Ostlie, Daniel J, Holcomb, George W
Format: Article
Language:English
Subjects:
Child, Preschool
Diaphragm - surgery
Dissection
Esophagus - surgery
Fundoplication - methods
Gastroesophageal Reflux - surgery
Humans
Infant
Infant, Newborn
Laparoscopy
Pediatrics
Postoperative Complications - prevention & control
Retrospective Studies
Surgery
Suture Techniques
Treatment Outcome
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Summary: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.
ISSN:0022-3468
1531-5037
DOI:10.1016/j.jpedsurg.2006.09.051