The modified Collis-Nissen operation for control of gastroesophageal reflux

An operation employing the Nissen fundoplication performed about an undivided 5 cm gastroplasty tube created with a gastrointestinal anastomosing (GIA) stapler that was modified by elimination of the cutting blade has been devised and evaluated in 48 patients over a period ranging from 3 to 52 months (average, 27 months). Seventeen of these patients had severe esophageal strictures. Reflux control, evaluated by clinical appraisal and roentgenograms in all patients and by 24-hour esophageal pH monitoring in some, has been complete in all patients throughout the study. One patient with undetected subclinical achalasia continues to have mild dysphagia and represents the only unsatisfactory result in the series. Normal swallowing has been restored to all patients with strictures, and the others remain free of symptoms. The simplicity, reproducibility, and effectiveness of this operation warrant its continuing evaluation.