title: Results of left thoracoscopic Collis gastroplasty with laparoscopic Nissen fundoplication for the surgical treatment of true short oesophagus in gastro-oesophageal reflux disease and Type III-IV hiatal hernia.
abstract: OBJECTIVE
  Controversy exists regarding surgery for true short oesophagus (TSOE). We compared the results of thoracoscopic Collis gastroplasty-laparoscopic Nissen procedure for the treatment of TSOE with the results of standard laparoscopic Nissen fundoplication.
  
  
  METHODS
  Between 1995 and 2013, the Collis-Nissen procedure was performed in 65 patients who underwent minimally invasive surgery when the length of the abdominal oesophagus, measured intraoperatively after maximal oesophageal mediastinal mobilization, was ≤1.5 cm. The results of the Collis-Nissen procedure were frequency-matched according to age, sex and period of surgical treatment with those of 65 standard Nissen fundoplication procedures in patients with a length of the abdominal oesophagus >1.5 cm. Postoperative mortality and morbidity were evaluated according to the Accordion classification. The patients underwent a timed clinical-instrumental follow-up that included symptoms assessment, barium swallow and endoscopy. Symptoms, oesophagitis and global results were graded according to semi-quantitative scales. The results were considered to be excellent in the absence of symptoms and oesophagitis, good if symptoms occurred two to four times a month in the absence of oesophagitis, fair if symptoms occurred two to four times a week in the presence of hyperaemia, oedema and/or microscopic oesophagitis and poor if symptoms occurred on a daily basis in the presence of any grade of endoscopic oesophagitis, hiatal hernia of any size or type, or the need for antireflux medical therapy. The follow-up time was calculated from the time of surgery to the last complete follow-up.
  
  
  RESULTS
  The postoperative mortality rate was 1.5% for the Collis-Nissen and 0 for the Nissen procedure. The postoperative complication rate was 24% for the Collis-Nissen and 7% for Nissen (P = 0.001) procedure. The complication rate for the Collis-Nissen procedure was 43% in the first 32 cases and 6% in the last 33 cases (P < 0.0001). The median follow-up period was 96 months. The results were: excellent in 27% of Collis-Nissen and 29% of Nissen; good in 64% of Collis-Nissen and 55% of Nissen; fair in 3% of Collis-Nissen and 11% of Nissen and poor in 6% of Collis-Nissen and 5% of Nissen (P = 0.87).
  
  
  CONCLUSIONS
  In patients affected by a TSOE, the Collis-Nissen procedure may achieve equally satisfactory results as the standard Nissen procedure in uncomplicated patients.
  
  
  BACKGROUND
  NCT02288988.
authors.affiliation: Division of Thoracic Surgery, Alma Mater Studiorum-University of Bologna, Bologna, Italy Center for the Study and Research on Diseases of the Oesophagus, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors.forename: Marialuisa
authors.initials: M
authors.lastname: Lugaresi
authors.affiliation: Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors.forename: Benedetta
authors.initials: B
authors.lastname: Mattioli
authors.affiliation: Division of Thoracic Surgery, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors.forename: Ottorino
authors.initials: O
authors.lastname: Perrone
authors.affiliation: Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors.forename: Niccolò
authors.initials: N
authors.lastname: Daddi
authors.affiliation: Center for the Study and Research on Diseases of the Oesophagus, Alma Mater Studiorum-University of Bologna, Bologna, Italy Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors.forename: Massimo Pierluigi
authors.initials: MP
authors.lastname: Di Simone
authors.affiliation: Division of Thoracic Surgery, Alma Mater Studiorum-University of Bologna, Bologna, Italy Center for the Study and Research on Diseases of the Oesophagus, Alma Mater Studiorum-University of Bologna, Bologna, Italy Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum-University of Bologna, Bologna, Italy GVM Care & Research, Cotignola, Italy sandro.mattioli@unibo.it.
authors.forename: Sandro
authors.initials: S
authors.lastname: Mattioli
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004947:Esophagus / Q000002:abnormalities* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000009:adverse effects / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D015391:Gastroplasty / Q000009:adverse effects / Q000379:methods*; D006551:Hernia, Hiatal / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D056888:Patient Positioning; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015996:Survival Rate; D013906:Thoracoscopy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
keywords: Gastro-oesophageal reflux disease; Hiatal hernia; Minimally invasive surgery; Short oesophagus