Are esophagocrural sutures needed during laparoscopic fundoplication: A prospective randomized trial

Area of Science:

• Pediatric surgery
• Gastrointestinal surgery
• Minimally invasive surgery

Background:

• Laparoscopic fundoplication is a common procedure for gastroesophageal reflux disease.
• Historically, extensive esophageal dissection was standard, but minimal dissection reduces complications.
• Esophagocrural (EC) sutures were previously used to prevent wrap herniation.

Purpose of the Study:

• To evaluate the necessity of EC sutures in pediatric laparoscopic fundoplication.
• To determine if EC sutures provide benefits when minimal esophageal dissection is employed.

Main Methods:

• A randomized trial involving children under 7 undergoing laparoscopic fundoplication.
• Patients were assigned to receive four EC sutures or no sutures.
• Primary outcome was wrap transmigration; secondary outcomes included reoperation rates and symptom recurrence.

Main Results:

• No significant difference in wrap herniation rates between groups.
• The group with EC sutures had a longer operative time (20 minutes longer).
• Reoperation for wrap loosening occurred in one patient in the no-suture group; none in the suture group.

Conclusions:

• EC sutures offer no advantage when minimal phrenoesophageal dissection is performed.
• EC sutures increase operative time without improving outcomes in this context.