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Zain M, Shehata S, Khairi A, Ashour K, Khalil AF, El-Sawaf M, Abouheba M. Role of Wrap-Crural Fixation and Minimal Dissection in Prevention of Transmigration After Laparoscopic Nissen Fundoplication in Children. J Laparoendosc Adv Surg Tech A 2021; 31:484-488. [PMID: 33493406 DOI: 10.1089/lap.2020.0952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Laparoscopic Nissen fundoplication is the gold standard antireflux procedure in pediatric age group. Intrathoracic migration of the fundic wrap is a common cause failure, leading to recurrence of gastroesophageal reflux disease (GERD) symptoms. Objectives: To investigate the impact of wrap-crural fixation and minimal esophageal dissection in prevention of wrap transmigration after laparoscopic Nissen fundoplication in children. Methods: Prospective randomized study of 46 pediatric patients with refractory GERD who underwent laparoscopic Nissen fundoplication divided into two equal groups. In Group A, wrap crural fixation was done, whereas in group B no fixation was done. Minimal esophageal dissection with preservation of the phrenoesophageal ligament was done in both groups. Approval of the Ethics Committee of our Faculty was obtained. Results: There was no difference between both groups regarding operative time, intraoperative complications, or length of hospital stay. Two patients in group B without wrap fixation suffered recurrence of GERD symptoms. On contrast study, they both showed intrathoracic wrap migration. One of them was reoperated. Whereas in group A, no recurrence of symptoms and no wrap transmigration were noticed in follow-up. Conclusion: In laparoscopic Nissen fundoplication, with minimal esophageal dissection and preservation of the phrenoesophageal ligament, there is no additional benefit from wrap-crural fixation in prevention of wrap transmigration.
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Affiliation(s)
- Mostafa Zain
- Department of Pediatric Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Sameh Shehata
- Department of Pediatric Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Ahmed Khairi
- Department of Pediatric Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Khaled Ashour
- Department of Pediatric Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Ahmed F Khalil
- Department of Pediatrics, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Mohamed El-Sawaf
- Department of Pediatric Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed Abouheba
- Department of Pediatric Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
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Chen Q, Rosen AK, Amirfarzan H, Rochman A, Itani KMF. Improving detection of intraoperative medical errors (iMEs) and intraoperative adverse events (iAEs) and their contribution to postoperative outcomes. Am J Surg 2018; 216:846-850. [PMID: 29563021 DOI: 10.1016/j.amjsurg.2018.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 02/25/2018] [Accepted: 03/02/2018] [Indexed: 12/18/2022]
Abstract
Our knowledge of the types of intraoperative patient safety events, their harm to patients, and relationship to postoperative complications is sparse. This study examined intraoperative medical errors (iMEs) and intraoperative adverse events (iAEs) voluntarily reported by providers using two programs at our hospital: surgical debriefing and incident reporting. Among the 3020 surgical procedures assessed, 142 iMEs and 103 iAEs were reported, yielding an overall rate of 8%. Of these events, 135 (55%) were obtained from incident reporting and 110 (45%) from surgical debriefing. The overall association between intraoperative events (iMEs and iAEs) and 30-day postoperative morbidity was significant (adjusted odds ratio = 1.08 with 95% confidence interval (CI) of (1.03, 1.13). This association was stronger when we included only the iAEs (1.47, 95% CI (1.35, 1.58)). Our findings suggest that hospitals should consider using both programs to obtain a more complete picture of intraoperative patient safety and to reduce postoperative morbidity.
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Affiliation(s)
- Qi Chen
- Patient Safety Center of Inquiry on Measurement to Advance Patient Safety, Boston, MA, USA; Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA; Department of Surgery, Boston University School of Medicine, Boston, MA, USA.
| | - Amy K Rosen
- Patient Safety Center of Inquiry on Measurement to Advance Patient Safety, Boston, MA, USA; Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA; Department of Surgery, Boston University School of Medicine, Boston, MA, USA
| | - Houman Amirfarzan
- Patient Safety Center of Inquiry on Measurement to Advance Patient Safety, Boston, MA, USA; Department of Anesthesiology, Critical Care and Pain Medicine, VA Boston Healthcare System, Boston, MA, USA
| | - Alexandra Rochman
- Patient Safety Center of Inquiry on Measurement to Advance Patient Safety, Boston, MA, USA; Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA
| | - Kamal M F Itani
- Patient Safety Center of Inquiry on Measurement to Advance Patient Safety, Boston, MA, USA; Department of Surgery, Boston University School of Medicine, Boston, MA, USA; Department of Surgery, VA Boston Healthcare System, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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