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Collis-Nissen procedure in patients with esophageal atresia: long-term evaluation
Hisayoshi Kawahara1, Kenji Imura, Makoto Yagi
1Department of Pediatric Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka Suita, Osaka 565-0871, Japan. kawahara@pedsurg.med.osaka-u.ac.jp
Insights
The Collis-Nissen procedure effectively manages gastroesophageal reflux and short esophagus in esophageal atresia (EA) patients. Long-term results show it
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Esophageal Atresia Management
Background:
- Esophageal atresia (EA) can present with a short esophagus, necessitating antireflux procedures.
- The Collis-Nissen procedure, combining Collis gastroplasty and Nissen fundoplication, is a surgical option for these complex cases.
- Long-term outcomes of the Collis-Nissen procedure in EA patients are infrequently reported.
Observation:
- This study evaluated four EA patients who underwent the Collis-Nissen procedure, with an average follow-up of 9 years.
- The procedure was performed in conjunction with other surgical interventions, including esophageal resection and primary EA repair.
- Patient follow-up included upper gastrointestinal studies, scintigraphy, and manometry.
Findings:
- The Collis-Nissen procedure demonstrated effective control of significant gastroesophageal reflux in all patients.
- Minor complications like anastomotic leakage and stenosis were manageable with postoperative dilation.
- Manometric examination indicated a reduction in swallow-related pressure at the fundoplication cuff.
Implications:
- The Collis-Nissen procedure is a viable and useful surgical option for EA patients requiring esophageal lengthening and reflux control.
- This approach addresses the challenges posed by short esophagus associated with esophageal atresia.
- Further long-term studies can elucidate the full impact of this combined surgical technique.
Abstract:
A subset of patients with esophageal atresia (EA) have an associated short esophagus and require an antireflux procedure. The Collis-Nissen procedure, which consists of a combination of Collis gastroplasty and Nissen fundoplication, is considered an option in such conditions. The long-term results of EA patients undergoing this procedure have rarely been reported. The results of the Collis-Nissen procedure were examined in four EA patients with follow-up for an average of 9 years. The Collis-Nissen procedure was conducted concurrently with segmental esophageal resection for an associated congenital esophageal stenosis close to the esophagogastric junction in two postoperative Gross type C patients (7 months, 2 years), as an antireflux operation in a postoperative Gross type A patient with an unreducible sliding hiatal hernia (10 years), and with primary repair of EA in a Gross type A patient with a long gap (4 months). There were no significant complications except minor anastomotic leakage and an anastomotic stenosis that required postoperative dilation. Significant reflux was negative, as shown by an upper gastrointestinal study and scintigraphy. Limited esophagitis just above the esophagogastric junction was observed in a Gross type A patient with a long mediastinal gastric segment. Swallow-related pressure reduction at the wrapping cuff was detected by manometric examination. The Collis-Nissen procedure is a useful option for treating EA patients who require esophageal lengthening and control of gastroesophageal reflux.