Adam S Weltz1, H Reza Zahiri1, Udai S Sibia1, Nan Wu1, George T Fantry2, Adrian E Park3. 1. Department of Surgery, Anne Arundel Medical Center, Annapolis, MD. 2. Department of Medicine, University of Maryland School of Medicine, Baltimore, MD. 3. Department of Surgery, Anne Arundel Medical Center, Annapolis, MD; Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: apark@aahs.org.
Abstract
BACKGROUND: Debate persists over the impact of Collis gastroplasty (CG) on outcomes after anti reflux surgery. This study analyzed operative and quality of life (QOL) outcomes from one of the largest series of laparoscopic anti reflux surgery (LARS) with CG reported to date. METHODS: A retrospective review was conducted to compare outcomes between patients undergoing LARS with CG versus without CG at two large centers with expertise in foregut surgery from October 2004-December 2011 and July 2012-September 2016. Demographic, perioperative, and QOL data were reviewed. Four validated surveys were used for QOL outcomes: reflux symptom index (RSI), gastroesophageal reflux disease health-related QOL (GERD-HRQL), laryngopharyngeal reflux health-related QOL (LPR-HRQL), and swallowing QOL (SWAL-QL). RESULTS: 480 patients consisted of 149 Collis vs 331 non-Collis with mean age of 66.3 vs 58.9 years (P ≤ .001), BMI of 28.6 vs 29.7 (P = .040) and ASA score of 2.4 vs 2.2 (P = .005) were included. Collis patients underwent longer duration operations (133.2 mins vs 94.2; P ≤ .001) with greater duration of hospital stay (3.1 vs 1.8; P ≤ .001). Thirty-day readmission and reoperation rates were equivalent between the two groups. Wound and non-wound related complications were also comparable. After mean 12 month follow up, QOL assessment revealed significant improvements for all patients post-surgery with comparable results between Collis and non-Collis patients. Furthermore, CG did not contribute to post-operative dysphagia, reflux, or a significant leak rate. CONCLUSION: Patients who require a CG to address a true short esophagus during LARS have comparable operative and QOL benefits as non-Collis patients without added morbidity or mortality.
BACKGROUND: Debate persists over the impact of Collis gastroplasty (CG) on outcomes after anti reflux surgery. This study analyzed operative and quality of life (QOL) outcomes from one of the largest series of laparoscopic anti reflux surgery (LARS) with CG reported to date. METHODS: A retrospective review was conducted to compare outcomes between patients undergoing LARS with CG versus without CG at two large centers with expertise in foregut surgery from October 2004-December 2011 and July 2012-September 2016. Demographic, perioperative, and QOL data were reviewed. Four validated surveys were used for QOL outcomes: reflux symptom index (RSI), gastroesophageal reflux disease health-related QOL (GERD-HRQL), laryngopharyngeal reflux health-related QOL (LPR-HRQL), and swallowing QOL (SWAL-QL). RESULTS: 480 patients consisted of 149 Collis vs 331 non-Collis with mean age of 66.3 vs 58.9 years (P ≤ .001), BMI of 28.6 vs 29.7 (P = .040) and ASA score of 2.4 vs 2.2 (P = .005) were included. Collis patients underwent longer duration operations (133.2 mins vs 94.2; P ≤ .001) with greater duration of hospital stay (3.1 vs 1.8; P ≤ .001). Thirty-day readmission and reoperation rates were equivalent between the two groups. Wound and non-wound related complications were also comparable. After mean 12 month follow up, QOL assessment revealed significant improvements for all patients post-surgery with comparable results between Collis and non-Collis patients. Furthermore, CG did not contribute to post-operative dysphagia, reflux, or a significant leak rate. CONCLUSION:Patients who require a CG to address a true short esophagus during LARS have comparable operative and QOL benefits as non-Collis patients without added morbidity or mortality.
Authors: Richard Lu; Alex Addo; Andrew Broda; Zachary Sanford; Adam Weltz; H Reza Zahiri; Adrian Park Journal: J Gastrointest Surg Date: 2019-11-25 Impact factor: 3.452