Minimally Invasive Collis Gastroplasty: Long Term Outcome
Abstracts
|
Background: Acquired esophageal foreshortening has been implicated as a cause of failure of laparoscopic fundoplication in patients with advanced gastroesophageal reflux (GERD). The intraoperative management of patients with shortened esophagus includes extensive esophageal mobilization and, at times, a lengthening procedure (Collis gastroplasty). Two minimally invasive techniques for performing Collis gastroplasty have previously been described by the authors (JH, LS), but longterm outcomes of these operations have not been reported. Methods: 51 patients (29 male, 22 female) underwent Collis gastroplasty with laparoscopic fundoplication between 12/93 and 7/00. Two patients have died of unrelated causes, and 38/49 (78%) of the remaining patients were able to complete a telephone query of symptoms, medical treatment & pt satisfaction. Median follow up is 44 months (range 17-96). Results: The preoperative diagnoses of those undergoing gastroplasty were paraesophageal hernia in 21/51 (41%), Barrett's esophagus in 11/51 (22%), esophageal stricture in 8/51 (16%) and GERD alone in 11/51 (22%). Additionally 7/51 (14%) had a failed previous antireflux operation. Collis gastroplasty was performed laparoscopically in 23 and thoracoscopically in 28. All procedures were completed with minimally invasive technique, and there were no deaths. At an average of 44 months, only 7/38 (18%) are symptomatic (heartburn in 4, dysphagia in 3) and all symptoms are controlled with medication. There are an additional 4 patients with no symptoms who take medication for a total of 11 patients (29%) on medications. Of the 18 patients who have had late postoperative endoscopy, five have endoscopic evidence of recurrent GERD (2 with esophagitis, 2 with stricture and 1 with both). Ninety-seven percent (37/38) have rated their outcomes as much improved compared to preop. Conclusions: While these results fall short of outcomes with laparoscopic fundoplication in patients with uncomplicated GERD, minimally invasive Collis gastroplasty provides complete symptom control in 80% of a complex set of patients at nearly 4 years follow-up. |
