The Collis-Nissen Operation for the Treatment of Acquired Short Esophagus and Esophageal Peptic Stricture
Abstracts
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Gastro-esophageal reflux disease, complicated by peptic stricture and short esophagus, is a challenging problem for which Collis gastroplasty with Nissen fundoplication (C-N) has been proposed as treatment. From 1983 to July 2001, C-N was performed in 38 pts (11 f and 27 m, median age 56, range 16-76 years) with diagnosis of esophageal peptic stricture and short esophagus confirmed by barium swallow, UGI endoscopy, pH monitoring and manometry. Post-operative follow-up was obtained in 33 patients (median follow-up 36, r. 2- 216 months); 16 patients had a follow up longer than 5 years. Pre and post-operative physiologic studies, symptom scores and needs for medication were compared with 226 patients with uncomplicated GERD treated with laparoscopic Nissen. The need for endoscopic dilations was analyzed within a group of 27 patients treated conservatively for peptic stricture (dilation and medication) with a median follow-up of 36 months (range 12-84). Patients who underwent C-N had similar pre-operative LES pressure (7, r. 3-30 vs. 8, r. 2-47 mmHg), but shorter lengths (29.5, r. 2.5-69 vs. 33, r. 11-71 mm) and higher exposure of acid in the distal esophagus (17%, r. 0.6-71 vs. 7%, r. 0-51, p< 0.05) compared to patients who underwent Nissen fundoplication. After the operation, LES pressure and lengths increased in both groups (13, r. 5-28 vs 12, r. 4-110 mmHg) and acid exposure decreased significantly (4.6%, r. 0-39.5 vs. 0% r. 0-27). However, abnormal 24-hour pH monitoring was detected in 10/23 patients after C-N and in 8/135 after Nissen fundoplication (p<0.05). During the follow-up 15/33 pts needed PPI or H2 blockers after C-N, vs. 18/173 after Nissen (p <0.05). Despite a less efficient control of reflux, the need of endoscopic dilation/pt to keep the esophagus patent decreased after operation (4 dilation/pt vs 1.1 dilation/pt) and the number of dilation/pt/year was significantly lower after the C-N compared to the group treated conservatively (0.17 vs 1.9, p< 0.05). Conclusion: The C-N operation for peptic stricture and short esophagus reduces the need of endoscopic dilation but the overall results in controlling acid exposure are less effective than those achieved by Nissen for uncomplicated GERD. |
