Combined Collis gastroplasty--fundoplication operations for scleroderma reflux esophagitis

Thirty-seven patients with scleroderma and reflux esophagitis, including 16 (43%) with peptic esophageal strictures, have been treated with a combination of the Collis gastroplasty and either a Belsey (240 degree) or Nissen (360 degree) fundoplication. Follow-up data have been obtained through personal interviews, esophageal manometry, and acid reflux testing. There have been no postoperative deaths or wound-healing complications. Five (31%) of the 16 patients with strictures still require intermittent dilatations. In the Collis-Belsey group (17 patients), after an average follow-up of 42 months, reflux symptoms have been eliminated in 11, are mild in three, and moderate or severe in three. Distal esophageal high-pressure zone (HPZ) tone and length have increased from an average of 4.6 mm Hg and 1.6 cm preoperatively to 8.6 mm Hg and 2.3 cm postoperatively. Acid reflux testing with the intraesophageal pH electrode, however, has demonstrated moderate-to-severe reflux in seven patients (41%). In the Collis-Nissen group (20 patients), after an average follow-up of 22 months, reflux symptoms have been eliminated in 17, are mild in two, and severe in one. Average HPZ tone and length have increased from 2.5 mm Hg and 1.2 cm preoperatively to 12 mm Hg and 4.2 cm postoperatively. The acid reflux test has revealed moderate or severe reflux in five patients (25%). Gratifying subjective and objective reflux control can be achieved in scleroderma patients with minimal operative morbidity.