In a previous two-center trial, we found that mobilization of
the distal esophagus by circumferentially dividing the
esophago-crural attachments predisposes to post-operative
herniation of the fundoplication wrap.
Currently, our recommendation is leave the phreno-esophageal
membrane intact. However, in the previous study, both groups
received four stitches between the esophagus and
crura; two on the right side, and two on the left.
In this study, we will compare the use of these four
esophago-crural sutures vs. not using these stitches. Similar
to the last study, hiatal herniation is the primary outcome
variable. Based on the wrap transmigration rates from the last
study, we will enroll 120 patients.