Minimally invasive approaches to acquired shortening of the esophagus: laparoscopic Collis-Nissen gastroplasty

Acquired shortening of the esophagus remains a controversial finding. In some surgical series of patients with gastroesophageal reflux disease, the incidence of clinically significant shortening is low enough that some surgeons have questioned its existence. In the setting of massive hiatial hernia, esophageal shortening has been reported to occur in up to 100% of patients. In association with mild to moderate hiatal hernia, clinically significant esophageal shortening is reported from 2.6% to a much higher percentage of patients, depending on the severity and chronicity of gastroesophageal reflux disease. Failure to recognize this shortening may be responsible for a high failure rate after antireflux surgery. Open Collis gastroplasty is an effective way to manage acquired shortening of the esophagus, and it creates a tension-free intra-abdominal segment of neoesophagus for fundoplication. Minimally invasive approaches to Collis-Nissen procedures have been reported by our group and several others with good short-term results.