Laparoscopic Collis gastroplasty and Nissen fundoplication |
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Authors: | A B Johnson M Oddsdottir J G Hunter |
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Institution: | (1) Department of Surgery, Emory University Hospital, Room H124C, 1364 Clifton Road, N.E., Atlanta, GA 30322, USA, US |
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Abstract: | Background: The short esophagus increases the difficulty and limits the effectiveness of laparoscopic Nissen fundoplication. In our experience,
∼20–25% of esophagi judged by preoperative criteria to be foreshortened will, after dissection, be insufficiently long to
allow 2 cm of esophagus to reside below the diaphragm without inferior distraction (i.e., tension free). Collis gastroplasty
combined with Nissen fundoplication has become the standard approach for the creation of an intraabdominal neoesophagus and
fundic wrap.
Methods: After developing methods of performing totally laparoscopic stapled gastroplasty in the cadaver lab in 1994, we started applying
the technique clinically in 1996. We performed 220 laparoscopic antireflux procedures between January 1996 and July 1997.
Of these 220 patients, 26% were suspected to have esophageal foreshortening based on preoperative barium studies and/or endoscopy.
Results: After hiatal dissection, nine patients, or 16% of those suspected to have esophageal foreshortening and 4% of the entire
population, required the laparoscopic Collis-Nissen procedure. There was symptomatic improvement in all patients as assessed
by patient-initiated symptom scores.
Conclusions: The management of patients with esophageal foreshortening is a complex problem. We believe that our technique of laparoscopic
Collis-Nissen provides an effective means of achieving intraabdominal placement of the fundic wrap while maintaining the benefits
of a minimally invasive approach.
Received: 8 September 1997/Accepted: 17 December 1997 |
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Keywords: | : Hiatal hernia — Paraesophageal hernia — Gastroesophageal junction — Esophageal stricture — Collis gastroplasty — Laparoscopic Nissen fundoplication |
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