Collis Nissen for the Short Collis Nissen for the Short Esophagus Esophagus

Bill Richards, Bill Richards, MD, FACSMD, FACSProfessor and Professor and Chair SurgeryChair Surgery

University of University of South AlabamaSouth Alabama

MISS 2011

Anatomic Fundoplication Anatomic Fundoplication Failure After Laparoscopic Failure After Laparoscopic Antireflux SurgeryAntireflux Surgery Soper Ann Soper Ann

SurgSurg

290 fundoplications over 6 year 290 fundoplications over 6 year periodperiod

7% anatomic failure of the 7% anatomic failure of the fundoplication demonstratedfundoplication demonstrated

Anatomic Failures: Does Anatomic Failures: Does Size Matter?Size Matter?

Soper Ann Surg 1999Soper Ann Surg 1999

> 3 cm > 3 cm HerniaHernia

12/90 (13%)12/90 (13%)

< 3 cm < 3 cm HerniaHernia

8/200 (4%)8/200 (4%)

Soper ConclusionsSoper Conclusions

3-4 cm intraabdominal length3-4 cm intraabdominal length No tensionNo tension

Risk of Needing a Collis Risk of Needing a Collis Urbach et al Surg Endosc 01Urbach et al Surg Endosc 01

79

6.4

9.9 10

2040

6080

Re-dosurgery

Primarysurgery

No stricture, Paraesophagealhernia or Barrett's

Stricture, Paraesophagealhernia or Barrett's

Odd's Ratio

No stricture, Paraesophageal hernia or Barrett's Stricture, Paraesophageal hernia or Barrett's

Prepare for Collis Prepare for Collis GastroplastyGastroplasty

Preop Preop determination of determination of >6 cm Hiatal >6 cm Hiatal Hernia Hernia

Recurrent Hiatal Recurrent Hiatal Hernia Hernia

Initial Type III Initial Type III repairsrepairs

Technique CollisTechnique Collis Intraoperative endoscopyIntraoperative endoscopy

Identify Z lineIdentify Z line Add 12 mm trocar in mid axillary line left Add 12 mm trocar in mid axillary line left

sideside 42 French dilator42 French dilator Increases esophageal length 4-5 cmIncreases esophageal length 4-5 cm EndoscopyEndoscopy

R/o leaks at end of procedureR/o leaks at end of procedure

Long-term Evaluation of patients Long-term Evaluation of patients satisfaction and reflux symptoms satisfaction and reflux symptoms

after Laparoscopic Fundoplication after Laparoscopic Fundoplication with Collis Gastroplastywith Collis Gastroplasty

Long-term Evaluation of patients Long-term Evaluation of patients satisfaction and reflux symptoms satisfaction and reflux symptoms

after Laparoscopic Fundoplication after Laparoscopic Fundoplication with Collis Gastroplastywith Collis Gastroplasty

Postoperative Function Following Postoperative Function Following Laparoscopic Collis Gastroplasty for Laparoscopic Collis Gastroplasty for

Shortened EsophagusShortened Esophagus

Blair, Horvath, Swanstrom Arch Surg. 1998;133:867-874.

Copyright restrictions may apply.

Jobe, B. A. et al. Arch Surg 1998;133:867-874.

Coronal section through a Coronal section through a Collis-Nissen fundoplicationCollis-Nissen fundoplication

The neoesophagus may The neoesophagus may contain functional contain functional gastric mucosa 50% of gastric mucosa 50% of the time,the time,

resulting in esophagitis resulting in esophagitis but with poor symptom but with poor symptom correlation. correlation.

This mandates the use of This mandates the use of medical acid suppression medical acid suppression when neoesophageal acid when neoesophageal acid production is production is documented. documented.

Collis NissenCollis Nissen Good technique for the truly short Good technique for the truly short

esophagus which does existesophagus which does exist 42 French bougie 42 French bougie wedge fundectomy techniquewedge fundectomy technique

Prepare for the case!Prepare for the case! Long term PPI useLong term PPI use Endoscopic surveillanceEndoscopic surveillance