Fundoplication without esophagocrural sutures: Long-term follow-up of a randomized clinical trial | Follow-up study from a randomized trial at 8.7 years post-op | 100 patients were alive | 70 included | (53% male) | 56% with Esophagocrural (EC) Sutures | 44% without EC Sutures | Follow-up = Chart Review + Phone Call | RESULTS | No significant difference between groups in | Rates of reflux | Hospitalizations for pneumonia | Failure to thrive | BRUE | No late wrap herniation in any group | Conclusion: Fundoplication without esophagocrural sutures appears to have no differences compared to the normal approach even in the long-term follow-up | DOI: 10.1016/j.jpedsurg.2021.12.006 | Source: Kayla Briggs et al. | Department of Surgery, Children's Mercy Hospital, Kansas City, MO, United States | @StayCurrentMD | @cecilipstick | Cincinnati Children's | Journal of Pediatric Surgery
Fundoplication without esophagocrural sutures: Long-term follow-up of a randomized clinical trial
Infographic · Nov 2022 · 1 min read
In brief
In brief
Long-term follow-up of a randomized trial demonstrates that fundoplication without esophagocrural sutures is safe and effective at median 8.7 years post-operatively. No difference in wrap herniation, reflux symptoms, or complications was found between groups, supporting simplified surgical technique.
- Esophagocrural sutures are not necessary during fundoplication when no esophageal dissection is performed
- No wrap herniation occurred in either group at median 8.7-year follow-up, regardless of EC suture use
- Omitting EC sutures does not increase rates of reflux recurrence, pneumonia, FTT, or BRUE long-term
- Simplified fundoplication technique without EC sutures maintains durable symptom control beyond 6.5 years
- 70% survey response rate at long-term follow-up provides robust evidence for technique safety
Written by the GCMD Library team from the infographic.
The infographic uses a teal and yellow color scheme with a header, flowchart-style patient breakdown, methodology icons (clipboard and phone), results section in white, and conclusion in yellow. Icons include a calendar with checkmark, clipboard, and telephone. The layout flows top to bottom with clear visual hierarchy.
Infographic by Cecilia Gigena
"Fundoplication without esophagocrural sutures: Long-term follow-up of a randomized clinical trial" Kayla Briggs et.al
Full article: https://www.jpedsurg.org/article/S0022-3468(21)00836-8/pdf
Authors: Kayla B. Briggs, Wendy Jo Svetanoff, James A. Fraser, Jason D. Fraser, George W. Holcomb III, Shawn D. St Peter
Abstract
Introduction
We previously conducted a randomized trial that showed a lack of need for esophagocrural (EC) sutures during fundoplication when no esophageal dissection was performed. There was no difference in wrap herniation or other complications in the group without EC sutures at a median 1.5 years of follow-up. In this follow-up study, we aim to evaluate long-term symptom control and complication profiles in these patients.
Methods
106 patients were randomized and participated in the original trial. We were primarily concerned with identification of late complications and persistence of symptoms. Presently, we conducted a retrospective chart review and a telephone follow-up survey at a minimum of 6.5 years after fundoplication.
Results
100 patients were alive at late follow-up and 70% of caregivers responded to the telephone survey. 53% of patients were male; 76% were Caucasian. Of these children, 39 (56%) received four EC sutures, while 31 (44%) did not. Follow-up was conducted at a median of 8.7 years [IQR 8.2,9.7] post-fundoplication.
Late wrap herniation was not demonstrated radiographically on chart review or caregiver report in either group. The rate of residual reflux symptoms, post-operative hospitalizations for pneumonia, failure to thrive (FTT), and brief resolved unexplained event (BRUE) were also similar between groups.
Conclusion
Long-term follow-up in children who underwent fundoplication without esophagocrural sutures demonstrates no difference in symptom management or subsequent hospitalizations at a minimum of 6.5-year follow-up.