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BACKGROUND: Short esophagus (SE) is defined as the inability of the gastro-esophageal junction to lay tension free 3 cm or more below the hiatus, after a high mediastinal dissection. If it is not recognized and treated a subsequent posibility of re-herniation and failure of the antireflux procedure increases, due to a repair under tension. Since the outcome of the Collis has had mixed reviews we studied the course of our patients undergoing the procedure.PATIENTS and METHODS: Eleven operated patients (2 Collis-Belsey and 9 Collis-Nissen), between 2001 and 2009, were followed up for a mean period of 43 months.Preop. Status: Chronic GERD symptoms partially controlled by PPI (permanent), with persistence of important regurgitation as the main symptom. Barium Swallow consistently showed a fixed hiatal hernia bigger than 5 cm, with easy reflux. At endoscopy 1 case showed long and 4 cases short Barrett’s esophagus, 4 patients presented erosive disease, and 2 cases normal mucosa. Manometry and 24 hs pHmetry were pathologic in all cases. Follow up: every patient had a clinical, radiological and endoscopic evaluation, both during the first year and after three years. Satisfaction with the procedure was surveyed.RESULTS: patients were followed up for a mean period of 43 months (6 patients with more than 5 years of follow up). One patient died after four years of surgery for unrelated causes.Clinical evaluation: All the patients controlled regurgitation. Two needed low dosis of PPI for mild heartburn. Nine complained of very mild dysphagia. All the patients improved their symptoms and would choose surgery again.Radiological study: showed no GE reflux, and no re-herniation in any patient.Endoscopy: no erosive lesions. The long Barrett’s desapeared, and the 4 short Barrett’s patients remained unchanged. Three patients had postop functional studies, with normal values of 24 hs pHmetry. Similar results (clinical evaluation, radiological study and endoscopy) were obteined after three years.During the same period of time, 15 other patients were operated with preop suspicion of SE, but in these cases it was possible to reduce the cardia into the abdomen without tension, after a high mediastinal dissection. There were four (27%) postop re-herniations in this group of patients. Another 145 patients were operated without preop suspicion of SE, and 11 patients (8%) presented hernia recurrence in the postop studies.CONCLUSIONS: the Collis procedure plus a funduplication turned out to be effective to restore the antireflux barrier controlling regurgitation, and healing peptic esophagitis. It was also adequated for the anatomical repair, avoiding re-herniation. All patients improved their symptoms, and they would choose the surgical option again, despite some mild postoperative discomfort. The good results were mantained over long-term follow up.