Results of left thoracoscopic Collis gastroplasty with laparoscopic Nissen fundoplication for the surgical treatment of true short oesophagus in gastro-oesophageal reflux disease and Type III–IV hiatal hernia

• Published in: European journal of cardio-thoracic surgery Vol. 49; no. 1; pp. e22 - e30
• Main Authors: Lugaresi, Marialuisa, Mattioli, Benedetta, Perrone, Ottorino, Daddi, Niccolò, Di Simone, Massimo Pierluigi, Mattioli, Sandro
• Format: Journal Article
• Language: English
• Published: Germany Oxford University Press 01.01.2016
• Subjects: Adult; Aged; Cohort Studies; Esophagus - abnormalities; Esophagus - surgery; Female; Follow-Up Studies; Fundoplication - adverse effects; Fundoplication - methods; Gastroesophageal Reflux - complications; Gastroesophageal Reflux - diagnosis; Gastroesophageal Reflux - surgery; Gastroplasty - adverse effects; Gastroplasty - methods; Hernia, Hiatal - complications; Hernia, Hiatal - diagnosis; Hernia, Hiatal - surgery; Humans; Laparoscopy - methods; Male; Middle Aged; Minimally Invasive Surgical Procedures - adverse effects; Minimally Invasive Surgical Procedures - methods; Patient Positioning; Postoperative Complications - mortality; Postoperative Complications - physiopathology; Retrospective Studies; Risk Assessment; Severity of Illness Index; Statistics, Nonparametric; Survival Rate; Thoracoscopy - adverse effects; Thoracoscopy - methods; Treatment Outcome; Minimally invasive surgery; Hiatal hernia; Short oesophagus; Gastro-oesophageal reflux disease
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezv381

OBJECTIVES Controversy exists regarding surgery for true short oesophagus (TSOE). We compared the results of thoracoscopic Collis gastroplasty–laparoscopic Nissen procedure for the treatment of TSOE with the results of standard laparoscopic Nissen fundoplication. METHODS Between 1995 and 2013, the Collis–Nissen procedure was performed in 65 patients who underwent minimally invasive surgery when the length of the abdominal oesophagus, measured intraoperatively after maximal oesophageal mediastinal mobilization, was ≤1.5 cm. The results of the Collis–Nissen procedure were frequency-matched according to age, sex and period of surgical treatment with those of 65 standard Nissen fundoplication procedures in patients with a length of the abdominal oesophagus >1.5 cm. Postoperative mortality and morbidity were evaluated according to the Accordion classification. The patients underwent a timed clinical–instrumental follow-up that included symptoms assessment, barium swallow and endoscopy. Symptoms, oesophagitis and global results were graded according to semi-quantitative scales. The results were considered to be excellent in the absence of symptoms and oesophagitis, good if symptoms occurred two to four times a month in the absence of oesophagitis, fair if symptoms occurred two to four times a week in the presence of hyperaemia, oedema and/or microscopic oesophagitis and poor if symptoms occurred on a daily basis in the presence of any grade of endoscopic oesophagitis, hiatal hernia of any size or type, or the need for antireflux medical therapy. The follow-up time was calculated from the time of surgery to the last complete follow-up. RESULTS The postoperative mortality rate was 1.5% for the Collis–Nissen and 0 for the Nissen procedure. The postoperative complication rate was 24% for the Collis–Nissen and 7% for Nissen (P = 0.001) procedure. The complication rate for the Collis–Nissen procedure was 43% in the first 32 cases and 6% in the last 33 cases (P < 0.0001). The median follow-up period was 96 months. The results were: excellent in 27% of Collis–Nissen and 29% of Nissen; good in 64% of Collis–Nissen and 55% of Nissen; fair in 3% of Collis–Nissen and 11% of Nissen and poor in 6% of Collis–Nissen and 5% of Nissen (P = 0.87). CONCLUSIONS In patients affected by a TSOE, the Collis–Nissen procedure may achieve equally satisfactory results as the standard Nissen procedure in uncomplicated patients. CLINICAL REGISTRATION NUMBER NCT02288988.