Elongation gastroplasty with transverse fundoplasty: the Jeyasingham repair.
OBJECTIVE
Surgical management of massive hernias and complex gastroesophageal reflux disease requires a tension-free repair with reliable reflux control. The aim of this observation was to evaluate the functional results of a modified Collis-Nissen gastroplasty with a transverse widening fundoplasty.


METHODS
Between 1995 and 2007, 26 patients underwent a 3-cm cut elongation gastroplasty with a transverse widening of the fundus followed by a 3-cm total (n = 24) or partial (n = 2) fundoplication. Indications for the operation were symptomatic massive hiatal hernias (n = 4), hiatal hernias with Barrett's esophagus (n = 8), or correction of previously failed antireflux fundoplications (n = 14). Barrett's esophagus was documented in 19 of the 26 patients. Pre- and postoperative assessment included symptoms, barium swallow, endoscopy, manometry, and 24-hour pH monitoring.


RESULTS
There was no postoperative mortality. Complications were recorded in 6 patients. Median follow-up was 105 months. Reflux symptoms present in all patients before the operation were found in 5 patients postoperatively (P < .001). Radiologic assessment documented an intact fundoplication in all patients. Lower esophageal sphincter gradient increased from a mean of 7.5 to 15 mm Hg (P = .003). Acid exposure (17% preoperatively) decreased significantly to 1% postoperatively (P < .001). Endoscopically, mucosal damage quantification decreased (3.1 preoperatively to 1.5 postoperatively; P < .001). All mucosal breaks healed but the columnar-lined metaplasia persisted.


CONCLUSIONS
This modified elongation gastroplasty provided a reliable repair for massive hernias, shortened Barrett's esophagus, and reoperations. The lower esophageal sphincter gradient was restored and remained stable. Reflux exposure was reduced, and acute mucosal damage disappeared. Columnar-lined metaplasia remained unchanged.
D'Journo
Xavier Benoit
XB
Department of Surgery, Université de Montréal, Division of Thoracic Surgery, Centre Hospitalier de l'Université de Montréal, 1560 rue Sherbrooke Est, Montréal, Québec, Canada.
Martin
Jocelyne
J
Bensaidane
Soufiane
S
Ferraro
Pasquale
P
Duranceau
André
A
D001471:Barrett Esophagus / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016145:Endoscopy, Digestive System; D050782:Esophageal pH Monitoring; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D015391:Gastroplasty / Q000379:methods*; D006551:Hernia, Hiatal / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome