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Postoperative function following laparoscopic collis gastroplasty for shortened esophagus
B A Jobe1, K D Horvath, L L Swanstrom
1Department of Minimally Invasive Surgery and Surgical Research, Oregon Health Sciences University and Legacy Portland Hospitals, 97227, USA.
Archives of Surgery (Chicago, Ill. : 1960)
|August 26, 1998
Summary
Laparoscopic Collis gastroplasty with fundoplication effectively corrects shortened esophagus and improves antireflux mechanisms. However, it may lead to acid-secreting gastric mucosa and reduced esophageal motility, requiring close monitoring and acid suppression.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Esophageal Physiology
Background:
- Collis gastroplasty is indicated for tension-free fundoplication when esophageal shortening is present.
- Limited data exists on the physiological outcomes of Collis gastroplasty, especially with endoscopic approaches.
Purpose of the Study:
- To evaluate the long-term outcomes of laparoscopic Collis gastroplasty combined with fundoplication.
- To assess the physiological effects and clinical results in patients with refractory esophageal shortening.
Main Methods:
- A case series of 15 patients with refractory esophageal shortening undergoing laparoscopic Collis gastroplasty and fundoplication.
- Preoperative and 14-month postoperative assessments included symptom evaluation, manometry, 24-hour pH monitoring, and endoscopy with biopsy.
Main Results:
- The procedure successfully created an intact antireflux mechanism with increased resting pressure.
- Postoperative findings included persistent heartburn in 14%, abnormal pH studies in 50%, and development of distal esophageal aperistalsis in 43% of patients.
- Acid-secreting gastric mucosa was identified in the neoesophagus of all patients.
Conclusions:
- Laparoscopic Collis gastroplasty enables tension-free fundoplication for shortened esophagus, establishing an effective antireflux barrier.
- Potential complications include acid-secreting gastric mucosa and impaired esophageal motility, necessitating long-term follow-up and acid suppression therapy.