Department of Surgery, Children's Mercy Hospital, Kansas City, MO, United States.
Department of Surgery, Children's Mercy Hospital, Kansas City, MO, United States.
J Pediatr Surg. 2022 Aug;57(8):1499-1503. doi: 10.1016/j.jpedsurg.2021.12.006. Epub 2021 Dec 11.
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.
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.
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.
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.
II (follow-up of a randomized controlled trial).
我们之前进行了一项随机试验，结果表明在没有进行食管切开术的情况下，胃食管褶（EC）缝合在胃底折叠术中并不需要。在中位随访 1.5 年时，没有 EC 缝线的组在包裹疝和其他并发症方面没有差异。在这项随访研究中，我们旨在评估这些患者的长期症状控制和并发症情况。
106 名患者被随机分组并参加了原始试验。我们主要关注的是晚期并发症和症状的持续存在。目前，我们对胃底折叠术至少 6.5 年后进行了回顾性图表审查和电话随访调查。
100 名患者在晚期随访时存活，70%的照顾者对电话调查做出了回应。53%的患者为男性；76%为白种人。这些儿童中，39 名（56%）接受了 4 个 EC 缝线，而 31 名（44%）没有。中位随访时间为胃底折叠术后 8.7 年[IQR 8.2，9.7]。在图表审查或照顾者报告中，两组均未显示出晚期包裹疝。残留反流症状、术后肺炎住院、生长发育迟缓（FTT）和短暂性不明原因事件（BRUE）的发生率在两组之间也相似。
对未接受 EC 缝线的胃底折叠术患儿进行长期随访，在至少 6.5 年的随访中，在症状管理或随后的住院治疗方面没有差异。
II（随机对照试验的随访）。
