Oliver C Bellevue1, Brian E Louie2, Zeljka Jutric1, Alexander S Farivar3, Ralph W Aye3. 1. Division of General Surgery, Swedish Medical Center, Seattle, WA, USA. 2. Division of Thoracic Surgery, Swedish Medical Center, 1101 Madison St., Suite 900, Seattle, WA, 98104, USA. brian.louie@swedish.org. 3. Division of Thoracic Surgery, Swedish Medical Center, 1101 Madison St., Suite 900, Seattle, WA, 98104, USA.
Abstract
INTRODUCTION: A Collis gastroplasty combined with a Nissen fundoplication is commonly used when a shortened esophagus is encountered. An alternative combines intra-abdominal fixation of the gastroesophageal junction via a Hill gastropexy with a Nissen fundoplication to maintain length and avoid juxtaposing acid-secreting tissue against the diseased esophagus. METHODS: A retrospective case-controlled analysis of 106 consecutive patients with short esophagus undergoing Hill-Nissen (HN) or Collis-Nissen (CN) was compared to a cohort of 105 matched patients without short esophagus undergoing primary Nissen fundoplication (NF). RESULTS: At a median follow-up of 27 months, all groups (HN:CN:NF) improved significantly over preoperative baseline with no differences in overall complications (18 vs 16 vs 19%, p = 0.78), DeMeester score (11.1 vs 19.1 vs 14.2, p = 0.49), postoperative PPI use (16 vs 22 vs 15%, p = 0.24), anatomic recurrences (11.7 vs 5.5 vs 7%, p = 0.43), or quality of life (6.8 vs 6.7 vs 6.4, p = 0.3). CONCLUSIONS: The management of shortened esophagus with Hill-Nissen is safe and as effective as Collis gastroplasty with Nissen fundoplication. Both options appear to produce similar outcomes to patients requiring only a Nissen fundoplication suggesting a shortened esophagus does not beget an inferior outcome.
INTRODUCTION: A Collis gastroplasty combined with a Nissen fundoplication is commonly used when a shortened esophagus is encountered. An alternative combines intra-abdominal fixation of the gastroesophageal junction via a Hill gastropexy with a Nissen fundoplication to maintain length and avoid juxtaposing acid-secreting tissue against the diseased esophagus. METHODS: A retrospective case-controlled analysis of 106 consecutive patients with short esophagus undergoing Hill-Nissen (HN) or Collis-Nissen (CN) was compared to a cohort of 105 matched patients without short esophagus undergoing primary Nissen fundoplication (NF). RESULTS: At a median follow-up of 27 months, all groups (HN:CN:NF) improved significantly over preoperative baseline with no differences in overall complications (18 vs 16 vs 19%, p = 0.78), DeMeester score (11.1 vs 19.1 vs 14.2, p = 0.49), postoperative PPI use (16 vs 22 vs 15%, p = 0.24), anatomic recurrences (11.7 vs 5.5 vs 7%, p = 0.43), or quality of life (6.8 vs 6.7 vs 6.4, p = 0.3). CONCLUSIONS: The management of shortened esophagus with Hill-Nissen is safe and as effective as Collis gastroplasty with Nissen fundoplication. Both options appear to produce similar outcomes to patients requiring only a Nissen fundoplication suggesting a shortened esophagus does not beget an inferior outcome.
Entities:
Keywords:
Collis gastroplasty; Hill repair; Nissen fundoplication; Short esophagus
Authors: Andrew J E Seely; Jelena Ivanovic; Jennifer Threader; Ahmed Al-Hussaini; Derar Al-Shehab; Tim Ramsay; Sebastian Gilbert; Donna E Maziak; Farid M Shamji; R Sudhir Sundaresan Journal: Ann Thorac Surg Date: 2010-09 Impact factor: 4.330
Authors: Blair A Jobe; Ralph W Aye; Clifford W Deveney; John S Domreis; Lucius D Hill Journal: J Gastrointest Surg Date: 2002 Mar-Apr Impact factor: 3.452