Personal Series - CMH Jan 2000 – March Pts No Esophagus – Crural Sutures Extensive Esophageal Mobilization Mean age/weight 21 mo/10 kg Mean operative time93 minutes Transmigration wrap15 (12%) Postoperative dilation0 APSA 2006 Accepted, J Pediatr Surg
Current Thoughts 1.Less mobilization of esophagus 2.Keep peritoneal barrier b/w esophagus & crura
Current Thoughts 3.Secure esophagus to crura at 8, 11, 1 and 4 o’clock
Personal Series - CMH April 2002 – December Pts Esophagus – Crural Sutures Minimal Esophageal Mobilization Mean age/weight 27 mo/11 kg Mean operative time102 minutes Transmigration wrap6 (5%) Postoperative dilation1 APSA 2006 Accepted, J Pediatr Surg
The relative risk of wrap transmigration in patients without esophago-crural sutures and with extensive esophageal mobilization was 2.29 times the risk if these sutures were utilized and if minimal esophageal dissection was performed.
Patients Less Than 60 Months Group I Jan 00-March Pts Group II April 02-Dec Pts P Value Mean Age (mos) Mean Wt (kg) Gastrostomy47%46%0.893 Neuro Impaired71%61%0.118 Wrap Transmigration 14 (12%) 6 (6%)0.159 The relative risk of transmigration of the wrap is 2.03 times greater for Group I than for Group II
Patients Less Than 24 Months Group I Jan 00-March Pts Group II April 02-Dec Pts P Value Mean Age (mos) Mean Wt (kg) Gastrostomy46% Neuro Impairment 73%60%0.069 Wrap Transmigration 13 (12%)6 (6%).226 The relative risk of transmigration of the wrap is 1.94 times greater for Group I than for Group II