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Update on the Durability and Performance of Collis Gastroplasty For Chronic GERD and Hiatal Hernia Repair At 4-Year
Richard Lu1, Alex Addo1, Andrew Broda1
1Department of Surgery, Anne Arundel Medical Center, Annapolis, MD, 21401, USA.
Insights
Collis gastroplasty (CG) provides comparable long-term quality of life outcomes to laparoscopic antireflux surgery alone for GERD and hiatal hernias. This important foregut surgery demonstrates durable results without increased dysphagia risk.
Area of Science:
- Gastroenterology
- Foregut Surgery
- Surgical Outcomes
Background:
- Collis gastroplasty (CG) is used to lengthen the esophagus during fundoplication for refractory GERD or large hiatal hernias.
- Debate exists regarding CG's potential side effects (dysphagia, heartburn) and long-term durability.
Purpose of the Study:
- To assess 3- and 4-year postoperative quality of life (QOL) in patients undergoing laparoscopic antireflux surgery (LARS) with and without CG.
- To compare QOL outcomes and durability between LARS with CG and LARS without CG.
Main Methods:
- A comparative review of a prospectively maintained GERD patient database from October 2004 to February 2019.
- Analysis of demographic, perioperative, and QOL data at 3 and 4 years postoperatively using validated surveys (RSI, LPR-QOL, SWAL, GERD-HRQOL).
Main Results:
- 214 CG patients and 798 non-CG (NC) patients were included. CG patients were older and had more comorbidities.
- No statistically significant differences in QOL outcomes were found between the CG and NC groups at 3 and 4 years.
- Most patients in both groups discontinued medication and reported satisfaction with surgical outcomes.
Conclusions:
- Long-term QOL outcomes after laparoscopic CG are comparable to fundoplication alone for GERD and hiatal hernias.
- CG offers durable results without an increased risk of subsequent dysphagia.
- Collis gastroplasty remains a valuable tool for foregut surgeons.
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 hiatal 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, 3 and 4-year postoperative data is presented assessing patient quality of life (QOL) measures for those undergoing laparoscopic antireflux surgery (LARS) with and without CG.
Methods:
Comparative review of a prospectively maintained GERD patient database was conducted between patients undergoing LARS with CG versus non-CG (NC) at two institutions between October 2004 and February 2019. Patient demographic, perioperative, and QOL data was analyzed at 3 and 4 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 214 CG and 798 NC patients were included in this study. The CG group was older (66.1 ± 12.9 vs. 59.0 ± 14.1, p < 0.001), had a higher frequency of ASA class 3 patients (39.7% vs. 29.7%), and had greater proportion of comorbid disease compared to NG. The groups were parallel in BMI (Collis 28.4 ± 5.2 kg/m2 vs. non-Collis 28.6 ± 5.3 kg/m2, p = 0.673). Subset analysis revealed persistent benefits through 4 years reflected by survey results in both groups. There were no statistically significant differences in QOL outcomes between CG and NC. A majority of patients in both groups reported discontinuation of antireflux medications and satisfaction with surgical outcomes and symptom control.
Conclusion:
Long-term QOL outcomes after laparoscopic CG are comparable to patients treated with fundoplication alone in cases of long-standing GERD and hiatal hernias. Furthermore, 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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