Laparoscopic wedge fundectomy for collis gastroplasty creation in patients with a foreshortened esophagus.
OBJECTIVE
To assess the outcome of a laparoscopic wedge-fundectomy Collis gastroplasty for a short esophagus during fundoplication and hiatal hernia repair.


BACKGROUND
The Collis gastroplasty provides a surgical solution for a foreshortened esophagus but has been associated with postoperative dysphagia and esophagitis.


METHODS
We identified 150 patients who underwent a Collis gastroplasty from 1998 to 2012, and of these, 85 patients underwent laparoscopic procedures using the wedge-fundectomy technique.


RESULTS
The median age of the 85 patients (42 men/43 women) was 66 years (range, 37-84 years). A Nissen fundoplication was added to the Collis gastroplasty in 56 patients (66%) and a Toupet fundoplication in 29 patients. No patient had a staple line leak or abscess, and the median hospital stay was 3.5 days (interquartile range, 3-4.5 days). At a median follow-up of 12 months, 93% of patients were free of heartburn. Dysphagia was significantly less common after surgery (preoperative: 58% vs postoperative: 16%; P < 0.0001). New-onset dysphagia developed in only 2 patients. An upper endoscopy was performed in 54 patients at a median of 6 months after surgery, and erosions above the fundoplication were seen in 6 patients (11%). A small (1-2 cm) recurrent hernia was seen in 2 patients (2.4%).


CONCLUSIONS
The laparoscopic wedge-fundectomy Collis gastroplasty can be performed safely and is associated with a low prevalence of new-onset dysphagia and esophagitis. The addition of a Collis gastroplasty to an antireflux operation is an effective strategy in patients with short esophagus, and its more liberal use is encouraged.
From the Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles.
Jörg
J
Zehetner
Steven R
SR
DeMeester
Shahin
S
Ayazi
Patrick
P
Kilday
Evan T
ET
Alicuben
Tom R
TR
DeMeester
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004935:Esophageal Diseases / Q000150:complications / Q000601:surgery*; D004947:Esophagus / Q000002:abnormalities* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D005748:Gastric Fundus / Q000601:surgery*; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000601:surgery; D015391:Gastroplasty / Q000379:methods*; D006551:Hernia, Hiatal / Q000209:etiology / Q000601:surgery; D059685:Herniorrhaphy; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome