The combined Collis-Nissen operation: early assessment of reflux control

This report summarizes the clinical experience with 155 patients who underwent the Collis-Nissen operation and have been followed by personal interview, esophageal manometry, barium swallow examination, and acid reflux testing for up to three years (average, 24 months). There has been 1 postoperative death. Major complications have included gastroplasty tube leak (2 patients), stricture perforation during dilation (1 patient), and splenic injury (3 patients). Subjectively, among 135 patients followed for a minimum of 6 months, reflux has been eliminated in 89% (120 patients), remains mild in 6% (8 patients), and is severe in 5% (7 patients). Early satiety ("bloats") of varying degree has occurred in 19% (26 patients), and dysphagia requiring dilation in 15% (20 patients). The overall objective recurrence rate, as documented with the intraesophageal pH probe and the standard acid reflux test, is 13% (18 patients). Among 32 patients with peptic strictures treated with dilation and the Collis-Nissen operation, reflux symptoms have recurred in 3%, and 6% have had abnormal reflux demonstrated with the pH probe. These results substantiate excellent early reflux control with the Collis-Nissen procedure and justify its continued use in appropriately selected patients with gastroesophageal efflux and its complications.