title: Quality of life after collis gastroplasty for short esophagus in patients with paraesophageal hernia.
abstract: BACKGROUND
  Collis gastroplasty is an important component of laparoscopic giant paraesophageal hernia (GPEH) repair in patients with persistent shortened esophagus after aggressive laparoscopic mobilization. Concerns remain, however, regarding symptomatic outcomes compared with fundoplication alone. This study assessed the impact of Collis gastroplasty on quality of life after laparoscopic GPEH repair.
  
  
  METHODS
  We performed 795 nonemergent laparoscopic GPEH repairs with fundoplication (with Collis, n = 454; fundoplication alone, n = 341). Radiographic follow-up and symptom assessment were obtained a median 22 months and 20 months, respectively, after fundoplication alone and 36 and 33 months, respectively, after Collis (p < 0.001). Radiographic recurrence, reoperation for recurrent hernia or intolerable symptoms, overall symptom improvement, and quality of life were examined.
  
  
  RESULTS
  Compared with fundoplication alone, Collis patients had significantly larger GPEH (p = 0.027) and fewer comorbidities (p = 0.002). Radiographic recurrences were similar (p = 0.353). Symptom improvement was significant for both (p < 0.001), although Collis was associated with better pain resolution (p < 0.001) and less gas bloat (p = 0.003). Quality of life was good to excellent in 88% (90% Collis versus 86% fundoplication alone, p = 0.17).
  
  
  CONCLUSIONS
  Symptomatic outcomes after laparoscopic fundoplication with Collis gastroplasty are excellent and comparable with those of fundoplication alone. These results confirm that utilization of Collis gastroplasty, based on intraoperative assessment for shortened esophagus, is not detrimental to the overall outcome or quality of life associated with the laparoscopic approach to GPEH. Collis gastroplasty is recommended as an important procedure in the surgeon's armamentarium for laparoscopic repair of GPEH.
authors.affiliation: Department of Cardiothoracic Surgery, University of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15232, USA. nasonks@upmc.edu
authors.forename: Katie S
authors.initials: KS
authors.lastname: Nason
authors.forename: James D
authors.initials: JD
authors.lastname: Luketich
authors.forename: Omar
authors.initials: O
authors.lastname: Awais
authors.forename: Ghulam
authors.initials: G
authors.lastname: Abbas
authors.forename: Arjun
authors.initials: A
authors.lastname: Pennathur
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Landreneau
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Schuchert
mesh_terms: D000368:Aged; D005260:Female; D018662:Fundoplication; D015391:Gastroplasty; D006551:Hernia, Hiatal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D011788:Quality of Life; D012189:Retrospective Studies