UPDATE ON THE DURABILITY AND PERFORMANCE OF COLLIS GASTROPLASTY FOR CHRONIC GERD AND PARAESOPHAGEAL HERNIA AT FOUR YEARS POST-INTERVENTION
Zachary Sanford, Adam S. Weltz, Alex Addo, Richard Lu*, Adrian Park
Minimally Invasive Surgery, Anne Arundel Medical Center, Annapolis, MD
Background
Collis gastroplasty (CG) remains an important procedure to lengthen the esophagus when indicated in patients undergoing fundoplication for longstanding refractory gastroesophageal reflux disease (GERD) or large paraesophageal hernias. Concerns over potential sequelae of CG such as dysphagia and worsening heartburn as well as questions regarding the durability of the procedure remain a subject of debate. In this study, three and four year postoperative data is presented assessing patient quality of life (QOL) measures for those undergoing laparoscopic foregut surgery (LFS) with and without CG.
Methods
Review of a prospectively maintained GERD patient database was conducted contrasting outcomes between patients undergoing LFS with CG versus non-CG (NC) at Anne Arundel Medical Center between March 2012 and December 2017. Patient demographic, perioperative, and QOL data was analyzed at three and four years postoperatively using four validated instruments: the Reflux Symptom Index (RSI), Laryngopharyngeal Reflux QOL (LPR-QOL), Swallowing QOL (SWAL), and Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQOL) surveys.
Results
A total of 195 CG and 634 NC patients underwent surgery during the period of this study. Of those, 121 surgeries including 35 CG and 86 NC procedures were analyzed through four years of postoperative observation (mean follow up 3.4 years). Mean age, BMI, and ASA score were 61.3 years, 28.4, and 2.3, respectively. Subset analysis revealed persistent benefits through four years reflected by survey results (RSI -24.9%, GERD-HRQOL -31.8%, LPR -16.7%, SWAL +12.9%). There were no statistically significant differences in dysphagia, GERD, swallowing scores, or measures of QOL among CG patients as compared to NC patients. A majority of patients in both groups reported discontinuation of antireflux medication. Patient satisfaction was excellent at long term follow up, with both groups reporting either "satisfied"? or "neutral"? in 91% of cases.
Conclusion
Long term QOL outcomes after laparoscopic CG are comparable to patients treated with fundoplication alone in cases of long standing GERD and paraesophageal hernias. Further CG patients enjoyed equivalent durability of the procedure without risk of subsequent dysphagia. Collis gastroplasty remains an important tool in the armamentarium of foregut surgeons.
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