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Are Posterior Crural Stitches Necessary in Pediatric Laparoscopic Fundoplication?
Wendy Jo Svetanoff1, Charlene Dekonenko1,2, Kayla B Briggs1
1Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, USA.
Insights
Posterior crural sutures are not necessary during laparoscopic fundoplication in children. This retrospective study found no difference in wrap migration or reoperation rates between patients who received sutures and those who did not.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
Background:
- Laparoscopic fundoplication is a common procedure for gastroesophageal reflux disease in children.
- Minimizing esophageal mobilization is key to reducing wrap transmigration.
- The role of posterior crural sutures in preventing wrap migration is debated.
Purpose of the Study:
- To evaluate the necessity of posterior crural sutures in preventing wrap migration during primary laparoscopic fundoplication in pediatric patients.
- To determine if posterior crural sutures impact recurrent symptoms or reoperation rates.
Main Methods:
- Retrospective review of 181 pediatric patients undergoing primary laparoscopic fundoplication between 2010 and 2019.
- Data collected included demographics, surgical details (use of posterior crural stitches), and outcomes.
- Primary outcome was transmigration of the fundoplication wrap; secondary outcomes included recurrent symptoms and reoperation.
Main Results:
- No significant difference in wrap migration incidence between the group with posterior crural stitches (34%) and the group without (66%).
- Rates of recurrent symptoms requiring workup and reoperation were similar between both groups.
- Operative time was not significantly different when controlling for concurrent procedures.
Conclusions:
- Posterior crural sutures do not appear to prevent wrap migration or herniation in pediatric laparoscopic fundoplication.
- The routine use of posterior crural sutures may not be necessary in this patient population.
- Further research could explore optimal surgical techniques for minimizing complications.
Abstract:
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. 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); P value <.05 was significant. 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). 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.
