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Antireflux Surgery for Barrett's Esophagus: Comparative Results of the Nissen and the Collis-Nissen Operations
Long-Qi Chen, Pasquale Ferraro, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada; Jocelyne Martin, Centre hospitalier de l'Université de Montréal, Montreal, Québec, Canada; André Duranceau, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
Background & Aim: The appropriate operation to treat reflux disease associated to Barrett's esophagus (BE) remains controversial. This paper compares the long-term results of Nissen and Collis-Nissen operations when treating this condition. Methods: Thirty-three patients underwent a standard Nissen fundoplication (Nissen) and 51 patients had a Collis-Nissen repair (CollisN) over a 25-year period. Symptoms, esophagogram, radionuclide emptying, manometry, 24-hour pH study, and endoscopy were assessed pre- and postoperatively. Operative failure was defined as either an abnormal fundoplication or mucosal damage, with or without reflux symptoms. Results: There were no operative deaths in either group. Evaluation of results at 8.3 years follow-up is summarized as follows:
| Observation | Preop Nissen | CollisN | P | Postop Nissen | CollisN | P |
| Reflux symptoms (%) | 91.9 | 90.2 | 0.786 | 51.9 | 6.9 | 0.001 |
| Emptying time (sec.) | 8.3 | 6.5 | 0.973 | 22.7 | 10.7 | 0.007 |
| LES gradient (mmHg) | 4.8 | 3.0 | 0.701 | 11 | 13 | 0.296 |
| LES relaxation (%) | 100 | 100 | 0.655 | 95 | 73.3 | 0.014 |
| Acid exposure (time %) | 17.6 | 11.8 | 0.099 | 5.4 | 1.6 | 0.095 |
| Mucosal erosions / ulcer (%) | 39.4 | 49 | 0.387 | 42.3 | 3.7 | 0.001 |
| Hiatal hernia / failed repair (%) | 69.7 | 49 | 0.061 | 34.6 | 0 | 0.003 |
| Cumulative success rate (%) | 63.2 | 90 | 0.004 |
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