title: Laparoscopic Collis gastroplasty and Nissen fundoplication for reflux esophagitis with shortened esophagus in Japanese patients.
abstract: BACKGROUND
  There is an extremely small number of surgical cases of laparoscopic Collis gastroplasty and Nissen fundoplication (LCN procedure) in Japan, and it is a fact that the surgical results are not thoroughly examined.
  
  
  OBJECTIVE
  To investigate the results of LCN procedure for shortened esophagus.
  
  
  METHODS
  The subjects consisted of 11 patients who underwent LCN procedure for shortened esophagus and followed for at least 2 years after surgery. The group of subjects consisted of 3 men and 8 women with an average age of 65.0+/-11.6 years, and an average follow-up period of 40.7+/-14.4 months. Esophagography, pH monitoring, and endoscopy were performed to assess preoperative conditions. Symptoms were clarified into 5 grades between 0 and 4 points, whereas patient satisfaction was assessed in 4 grades. The use of postoperative acid-reducing medication and the recurrence of esophagitis were also investigated.
  
  
  RESULTS
  None of the patients experienced intraoperative complications, received transfusions, required conversion to open surgery, or died postoperatively. The average preoperative heartburn, regurgitation, and dysphagia scores were 2.36+/-1.29, 2.27+/-1.19, and 1.82+/-1.78 points, respectively. These scores improved after surgery to 0.55+/-1.21 (P=0.0063), 0.55+/-1.21 (P=0.0094), and 1.0+/-1.18 (P=0.1236) points, respectively. All patients had esophagitis preoperatively, which recurred in 3 patients (27%). In these 3 patients, acid-secreting mucosa was confirmed on the oral side of the wrap, by positive Congo-red staining. Hiatal hernia recurred in one patient, who also experienced recurrent esophagitis. Five patients received acid-reducing medication postoperatively. The degree of satisfaction was excellent in 2, good in 6 patients, fair in 2, and poor in 1 patient(s).
  
  
  CONCLUSIONS
  Although the LCN procedure can be performed safely, the outcome was not necessarily satisfactory. The LCN procedure requires avoidance of residual acid-secreting mucosa on the oral side of the wrapped neoesophagus. If acid-secreting mucosa remains, continuous acid suppression therapy should be employed postoperatively.
authors.affiliation: Department of Surgery, Jikei University School of Medicine, Minato-ku, Tokyo, Japan. kazuto@jikei.ac.jp
authors.forename: Kazuto
authors.initials: K
authors.lastname: Tsuboi
authors.forename: Nobuo
authors.initials: N
authors.lastname: Omura
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Kashiwagi
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Yano
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Ishibashi
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Naruo
authors.initials: N
authors.lastname: Kawasaki
authors.forename: Norio
authors.initials: N
authors.lastname: Mitsumori
authors.forename: Mitsuyoshi
authors.initials: M
authors.lastname: Urashima
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Yanaga
mesh_terms: D000368:Aged; D004942:Esophagitis, Peptic / Q000150:complications / Q000601:surgery*; D004947:Esophagus / Q000473:pathology*; D005260:Female; D018662:Fundoplication; D015391:Gastroplasty / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D016896:Treatment Outcome