Continued assessment of the combined Collis-Nissen operation.
The combined Collis-Nissen operation has been performed in 353 patients. Forty-five percent had reflux esophagitis without stricture; 20%, peptic stricture; 72%, a sliding hiatal hernia; 17%, a paraesophageal hernia; 21%, previous antireflux operation; 15%, esophageal spasm; 8%, scleroderma; and 32%, marked obesity. There were 4 postoperative deaths (mortality rate, 1.1%). Complications occurred in 28 patients (8%) and included wound infection (2.2%), esophageal or gastroplasty tube leak (1.7%), bleeding (1.1%), splenic injury, gastric atony, and crural repair dehiscence (each less than 1%). Follow-up includes personal interview, esophageal manometry, and standard acid reflux testing. The average length of follow-up for 261 patients (74%) followed at least 12 months is 43.8 months. Fifty-eight percent have been followed at least 36 months; 41%, 48 months; and 29%, 60 months or longer. Subjectively, in these 261 patients, reflux has been eliminated in 75%, is mild in 11%, is moderate in 9%, and is severe in 5%. Eight percent have postthoracotomy pain; 3%, early satiety ("bloats"); and 1%, postvagotomy diarrhea. Seventeen percent require either periodic or regular esophageal dilations for dysphagia. Objectively, intraesophageal pH studies show good reflux control in 91% and poor reflux control in 9%. Twenty-six patients (10%) have required reoperation for recurrent reflux or dysphagia. These results substantiate satisfactory reflux control using the Collis-Nissen operation in patients at risk for recurrence after standard repairs, but also emphasize that, like other antireflux procedures, the Collis-Nissen operation is not without some degree of postoperative adverse symptoms.
Stirling
M C
MC
Section of Thoracic Surgery, University of Michigan Medical Center, Ann Arbor 48109.
Orringer
M B
MB
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004947:Esophagus / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000503:physiopathology / Q000601:surgery*; D015391:Gastroplasty / Q000379:methods; D006801:Humans; D008297:Male; D008722:Methods; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation