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Collis Gastroplasty Is Over-Used: Prospective Data Base Analysis and Surgical Outcomes Review
Daniel Lomelin, Amareshewar Chiruvella, Christopher Crawford, Crystal Krause, Dmitry Oleynikov*
Surgery, University of Nebraska Medical Center, Omaha, NE
Introduction:
Shortened esophagus is observed in approximately 10% of patients that receive anti-reflux procedures. While Collis gastroplasty (CG) has been deemed a gold standard of esophageal lengthening, there is disagreement on whether most patients require CG as opposed to mediastinal dissection. This study examines the rates of CG use at our institution in patients with paraesophageal hernias (PH) greater than 5cm.
Methods:
Patients with hiatal hernia who were undergoing anti reflux surgery had their medical records examined from our institutionally-maintained prospective database from 2002 to 2014. Merging, cleaning of datasets, and descriptive statistics were conducted using SPSS v22.0.0.0. Long-term symptom progression was evaluated against baseline using the sign-rank test and Bonferroni correction for multiple comparisons.
Results:
643 patients had hiatal hernia repair with a total of 180 patients identified with PH >5cm [type III &IV}; typical hernia size was 6.5cm (SD: 1.7cm), intra-thoracic stomach had a prevalence of approximately 25%. Median age was 60.5 years old (IQR: 51.25-69.75). N=76 (42.2%) patients were male, while N=104 (57.8%) were female. Mean BMI was 30.6 kg/m2 (SD: ±5.7 kg/m2). Of these patients, N=3 (1.67%) required CG. All patients who did not need CG, had a median of 3.15 cm [range of 3-5cm} of intra-abdominal esophagus mobilized with extensive mediastinal dissection. Median follow-up was 25 months with 21% asymptomatic hiatal hernia recurrence and significant improvement in all symptoms scores.
Conclusion:
Previous literature has varied widely in the reported proportion of patients requiring CG, our results support the conclusion that CG is not necessary in the vast majority of cases, even with PH >5cm. In such cases, the use of more extensive mediastinal dissection was used successfully in place of neo-esophagus creation with durable, long-term outcomes.
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