PURPOSE:Laparoscopic Nissen fundoplication has been traditionally performed with extensive esophageal dissection to create 2 to 3 cm of intraabdominal esophagus. Retrospective data have suggested that minimal esophageal mobilization may reduce the risk of postoperative herniation of the wrap into the lower mediastinum. To compare complete esophageal dissection to leaving the phrenoesophageal attachment intact, we conducted a 2-center, prospective, randomized trial. METHODS: After obtaining permission/assent, patients were randomized to circumferential division of the phrenoesophageal attachments (MAX) or minimal mobilization with no violation of the phrenoesophageal membrane (MIN). A contrast study was performed at 1 year. The primary outcome variable was postoperative wrap herniation. RESULTS:One hundred seventy-seven patients were enrolled in the study (MIN, n = 90; MAX, n = 87) from February 2006 to May 2008. There were no differences in demographics or operative time. Contrast studies were performed in 64 MIN and 71 MAX patients, respectively. The transmigration rate was 30% in the MAX group compared with 7.8% in the MIN group (P = .002). The reoperation rate was 18.4% in the MAX group and 3.3% in the MIN group (P = .006) CONCLUSIONS: Minimal esophageal mobilization during laparoscopic fundoplication decreases postoperative wrap transmigration and the need for a redo operation. Copyright Â
RCT Entities:
PURPOSE: Laparoscopic Nissen fundoplication has been traditionally performed with extensive esophageal dissection to create 2 to 3 cm of intraabdominal esophagus. Retrospective data have suggested that minimal esophageal mobilization may reduce the risk of postoperative herniation of the wrap into the lower mediastinum. To compare complete esophageal dissection to leaving the phrenoesophageal attachment intact, we conducted a 2-center, prospective, randomized trial. METHODS: After obtaining permission/assent, patients were randomized to circumferential division of the phrenoesophageal attachments (MAX) or minimal mobilization with no violation of the phrenoesophageal membrane (MIN). A contrast study was performed at 1 year. The primary outcome variable was postoperative wrap herniation. RESULTS: One hundred seventy-seven patients were enrolled in the study (MIN, n = 90; MAX, n = 87) from February 2006 to May 2008. There were no differences in demographics or operative time. Contrast studies were performed in 64 MIN and 71 MAX patients, respectively. The transmigration rate was 30% in the MAX group compared with 7.8% in the MIN group (P = .002). The reoperation rate was 18.4% in the MAX group and 3.3% in the MIN group (P = .006) CONCLUSIONS: Minimal esophageal mobilization during laparoscopic fundoplication decreases postoperative wrap transmigration and the need for a redo operation. Copyright Â
Authors: Shawn D St Peter; Patricia A Valusek; Casey M Calkins; Steven B Shew; Daniel J Ostlie; George W Holcomb Journal: J Pediatr Surg Date: 2007-01 Impact factor: 2.545
Authors: Yang K Chen; Isaac Raijman; Tamir Ben-Menachem; Anthony A Starpoli; Julia Liu; Haleh Pazwash; Stacey Weiland; Mamun Shahrier; Evelina Fortajada; John R Saltzman; David L Carr-Locke Journal: Gastrointest Endosc Date: 2005-05 Impact factor: 9.427
Authors: James G Brasseur; Rhys Ulerich; Qing Dai; Dalipkumar K Patel; Ahmed M S Soliman; Larry S Miller Journal: J Physiol Date: 2007-02-08 Impact factor: 5.182
Authors: Patricia A Valusek; Shawn D St Peter; Kuojen Tsao; Troy L Spilde; Daniel J Ostlie; George W Holcomb Journal: J Pediatr Surg Date: 2007-06 Impact factor: 2.545
Authors: Geoffrey Paul Kohn; Raymond Richard Price; Steven R DeMeester; Jörg Zehetner; Oliver J Muensterer; Ziad Awad; Sumeet K Mittal; William S Richardson; Dimitrios Stefanidis; Robert D Fanelli Journal: Surg Endosc Date: 2013-09-10 Impact factor: 4.584
Authors: Bethany J Slater; Rebecca C Dirks; Sophia K McKinley; Mohammed T Ansari; Geoffrey P Kohn; Nirav Thosani; Bashar Qumseya; Sarah Billmeier; Shaun Daly; Catherine Crawford; Anne P Ehlers; Celeste Hollands; Francesco Palazzo; Noe Rodriguez; Arianne Train; Eelco Wassenaar; Danielle Walsh; Aurora D Pryor; Dimitrios Stefanidis Journal: Surg Endosc Date: 2021-07-19 Impact factor: 4.584
Authors: Si Eun Hwang; Ji Hyun Kim; Sang In Bae; José Francisco Rodríguez-Vázquez; Gen Murakami; Baik Hwan Cho Journal: Anat Cell Biol Date: 2014-12-23
Authors: Maurizio Pacilli; Simon Eaton; Merrill McHoney; Edward M Kiely; David P Drake; Joseph I Curry; Keith J Lindley; Agostino Pierro Journal: Arch Dis Child Date: 2014-02-14 Impact factor: 3.791