title: A novel continuous stitch fundoplication utilizing knotless barbed suture in children with gastroesophageal reflux disease: a pilot study.
abstract: BACKGROUND
  The intracorporeal placement and tying of suture (IT) can be challenging leading to prolonged CO2 insufflation, anesthesia, and potential morbidity. The unidirectional barbed knotless suture (V-LOC) has emerged as an innovative technology that has been shown to reduce the time associated with IT. Therefore, we conducted a retrospective analysis comparing our initial experience utilizing V-LOC to perform a novel continuous stitch laparoscopic fundoplication (CF) to standard laparoscopic Nissen fundoplication (NF).
  
  
  METHODS
  Institutional review board approval was obtained to analyze data on patients who underwent V-LOC CF and NF. Data retrieval included age, gender, weight, diagnosis, procedure, operative time, major complications (reoperation for wrap failure/migration or recurrent symptoms), and follow up.
  
  
  RESULTS
  Twenty patients underwent the V-LOC CF and gastrostomy placement (GT) from January to October 2013. Seventeen patients underwent NF and GT from March 2012 to February 2013. There were no significant differences in age, weight, or incidence of major complications. V-LOC CF led to a significant 30% reduction in operative time compared to NF (79.1±24.2 min vs. 113.8±25.9 min, respectively, P<0.05).
  
  
  CONCLUSIONS
  This is the first report documenting the continuous stitch fundoplication utilizing the unidirectional barbed knotless suture in children. Although follow-up is short, the V-LOC CF appears to be a safe and effective technique that may reduce operative time in children with gastroesophageal reflux disease. This technology may be beneficial in other minimally invasive applications in pediatric surgery.
authors: Division of Pediatric Surgery, Department of Surgery, The Johns Hopkins University, Baltimore, MD, United States. Electronic address: jlukish1@jhmi.edu.
authors: Jeffrey
authors: J
authors: Lukish
authors: Division of Pediatric Surgery, Department of Surgery, The Johns Hopkins University, Baltimore, MD, United States.
authors: Howard
authors: H
authors: Pryor
authors: Division of Pediatric Surgery, Department of Surgery, The Johns Hopkins University, Baltimore, MD, United States.
authors: Daniel
authors: D
authors: Rhee
authors: Division of Pediatric Surgery, Department of Surgery, The Johns Hopkins University, Baltimore, MD, United States.
authors: Jose
authors: J
authors: Salazar
authors: Division of Pediatric Surgery, Department of Surgery, The Johns Hopkins University, Baltimore, MD, United States.
authors: Seth
authors: S
authors: Goldstein
authors: Division of Pediatric Surgery, Department of Surgery, The Johns Hopkins University, Baltimore, MD, United States.
authors: Colin
authors: C
authors: Gause
authors: Division of Pediatric Surgery, Department of Surgery, The Johns Hopkins University, Baltimore, MD, United States.
authors: Dylan
authors: D
authors: Stewart
authors: Division of Pediatric Surgery, Department of Surgery, The Johns Hopkins University, Baltimore, MD, United States.
authors: Fizan
authors: F
authors: Abdullah
authors: Division of Pediatric Surgery, Department of Surgery, The Johns Hopkins University, Baltimore, MD, United States.
authors: Paul
authors: P
authors: Colombani
mesh_terms: D004867:Equipment Design; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods; D008297:Male; D010865:Pilot Projects; D012189:Retrospective Studies; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures
keywords: Barbed suture; Nissen fundoplication; Pediatric surgery