title: Treatment of advanced gastroesophageal reflux disease with Collis gastroplasty and Belsey partial fundoplication.
abstract: OBJECTIVE
  To examine the factors affecting outcome in patients with advanced gastroesophageal reflux disease.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  University tertiary referral center.
  
  
  METHODS
  Thirty-seven patients with advanced gastroesophageal reflux disease and no previous antireflux surgery.
  
  
  METHODS
  Thirty patients underwent Collis gastroplasty for esophageal lengthening and Belsey partial fundoplication. Seven patients with esophageal stricture and global loss of esophageal body motility who underwent primary esophagectomy and reconstruction were used as a comparison group.
  
  
  METHODS
  Symptomatic outcome in all 37 patients was assessed by questionnaire at a median of 25 months (range, 5-156 months) after surgery. In a subset of 11 patients undergoing the Collis-Belsey procedure, outcome was measured using 24-hour pH and results of motility studies.
  
  
  RESULTS
  The Collis-Belsey procedure was successful in relieving symptoms of gastroesophageal reflux in 21 (70%) of the 30 patients. The outcome was excellent or good in 16 (89%) of 18 patients who presented with symptoms other than dysphagia, but only in 5 (42%) of 12 patients with dysphagia (P = .01). The outcome was particularly poor if dysphagia was associated with a previously dilated esophageal stricture. Persistent or induced dysphagia was the reason for failure in all but 1 patient. Results of 24-hour esophageal pH studies were returned to normal in 8 (73%) of 11 patients undergoing postoperative evaluation. Contraction amplitudes in the distal esophagus and the prevalence of simultaneous contractions in these segments did not change after the operation. All 7 patients who underwent primary esophagectomy were classified as having an excellent or good outcome and were relieved of their reflux symptoms, including dysphagia. Six of these could eat 3 meals per day and enjoyed an unrestricted diet.
  
  
  CONCLUSIONS
  The outcome of the Collis-Belsey procedure in patients with advanced gastroesophageal reflux disease without dysphagia is excellent. It is less so in patients with dysphagia as a preoperative symptom. Esophagectomy can provide a good outcome in patients who have a combination of dysphagia stricture and a profound loss of esophageal motility.
authors.affiliation: Department of Surgery, University of Southern California School of Medicine, Los Angeles 90033-4612, USA.
authors.forename: M P
authors.initials: MP
authors.lastname: Ritter
authors.forename: J H
authors.initials: JH
authors.lastname: Peters
authors.forename: T R
authors.initials: TR
authors.lastname: DeMeester
authors.forename: M
authors.initials: M
authors.lastname: Gadenstätter
authors.forename: S
authors.initials: S
authors.lastname: Oberg
authors.forename: M
authors.initials: M
authors.lastname: Fein
authors.forename: J A
authors.initials: JA
authors.lastname: Hagen
authors.forename: P F
authors.initials: PF
authors.lastname: Crookes
authors.forename: C G
authors.initials: CG
authors.lastname: Bremner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000503:physiopathology / Q000601:surgery*; D015391:Gastroplasty / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome