title: Minimal vs. maximal esophageal dissection and mobilization during laparoscopic fundoplication: long-term follow-up from a prospective, randomized trial.
abstract: OBJECTIVE
  We have previously conducted a prospective randomized trial (PRT) comparing circumferential phrenoesophageal dissection and esophageal mobilization (MAX) to minimal dissection/mobilization (MIN). The MIN group had a decreased incidence of postoperative wrap herniation and need for reoperation. This study provides long-term follow-up of the patients from our center who participated in the PRT.
  
  
  METHODS
  Parents of patients in the PRT were queried regarding symptoms, medication use, postoperative complications, and additional procedures. Medical records were reviewed. Student's t-test was used for continuous variables. Fisher's exact and chi-square with Yates correction were used where appropriate.
  
  
  RESULTS
  Of patients from our center, 75.4% MAX and 72.5% MIN patients were contacted. Median time to follow-up was 6.5 years. A rise in the incidence of herniation was noted in both groups (22.7% to 36.5% MAX vs 2.8% to 12.2% MIN). Time to diagnosis of hernia was significantly longer in the MIN group (14.7±9.5 months MAX vs 30.2±23.6 months MIN, P=0.04). There was no significant difference between MIN and MAX group in reflux symptoms or medication use.
  
  
  CONCLUSIONS
  Long-term follow-up demonstrates an increase in incidence of herniation in both groups. Previously demonstrated higher risk of wrap herniation with maximal esophageal dissection during laparoscopic fundoplication remains supporting original findings.
authors.affiliation: The Children's Mercy Hospital, Kansas City, MO, United States.
authors.forename: Amita A
authors.initials: AA
authors.lastname: Desai
authors.affiliation: The Children's Mercy Hospital, Kansas City, MO, United States.
authors.forename: Hanna
authors.initials: H
authors.lastname: Alemayehu
authors.affiliation: The Children's Mercy Hospital, Kansas City, MO, United States.
authors.forename: G W
authors.initials: GW
authors.lastname: Holcomb
authors.affiliation: The Children's Mercy Hospital, Kansas City, MO, United States. Electronic address: sspeter@cmh.edu.
authors.forename: Shawn D
authors.initials: SD
authors.lastname: St Peter
mesh_terms: D000328:Adult; D000368:Aged; D004210:Dissection / Q000379:methods*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006301:Health Services Needs and Demand; D006551:Hernia, Hiatal / Q000601:surgery; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology
keywords: Children; Laparoscopic Nissen fundoplication; Pediatrics