Is there a proper way to treat shortened oesophagus? About a series of 67 patients.
OBJECTIVE
During the work-up of gastro-oesophageal reflux disease (GORD) patients, barium swallow may show a shortened oesophagus with a non-reducible gastro-oesophageal junction. In our department, in such cases, a Collis-Nissen operation is usually planned. But, the proper reducibility of the gastro-oesophageal junction (GOJ) in the abdomen is difficult to assess peroperatively. The aim of this study is to compare retrospectively the follow-up of an oesophageal lengthening procedure (Collis-Nissen gastroplasty) versus a standard Nissen in the management of patients with primary short oesophagus or secondary to previous Nissen fundoplication.


METHODS
Between 01/2000 and 12/2009, 67 patients with a short oesophagus on X-Ray were operated on for proven GORD: 27 (Group A) underwent a Collis-Nissen fundoplication. In 40 patients (Group B), the GOJ was reduced easily and a standard Nissen fundoplication was judged sufficient by the experimented surgeon. Follow up included Quality of Life evaluation using the Gastrointestinal Quality of Life Index (GIQLI) and a barium swallow.


RESULTS
64 patients agreed to participate. Mean follow up was 46 months (4-122). Mean postoperative GIQLI score was 108 in group A, 97 in group B. Barium swallow was performed in 61 patients. In group A, seven patients out of 25 (28%) presented a intrathoracic migration on X-Ray while in group B, it was noted in 20 patients (55%).


CONCLUSIONS
According literature, Collis gastroplasty allows a tension-free fundoplication to be performed to correct a shortened oesophagus. Though our series of brachy-oesophagus is small, it confirms a better outcome after a Collis-Nissen gastroplasty, compared to the classical Nissen fundoplication.
Pirard
L
L
Department of Abdominal Surgery, CHC Clinique Saint-Joseph, Liège, Belgium.
Weerts
J M
JM
Buldgen
B
B
Deben
L
L
Dewandre
J M
JM
Francart
D
D
Monami
B
B
Markiewicz
S
S
Wahlen
Chr
C
Jehaes
C
C
D000328:Adult; D000368:Aged; D004947:Esophagus / Q000601:surgery*; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000601:surgery; D015391:Gastroplasty / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies