Transthoracic Gastroplasty (Collis) and Nissen Fundoplication

Abstract

As discussed in the previous chapters (see esp. Chap. 66), this operation is indicated in patients with reflux esophagitis that has caused a significant degree of fibrosis, constriction, and shortening of the esophagus. In some patients without much esophageal shortening, advanced fibrosis itself will interfere with the antireflux efficiency of a fundoplication because the rigid esophageal walls will not be compressed by the fundoplication. For this reason, Pearson and Henderson; Urschel, Razzuk, Wood, Galbraith et al.; and Orringer and colleagues (see Chap. 66) believe that almost every esophageal stricture caused by reflux should be treated by a Collis gastroplasty and an antireflux procedure. A previous high subtotal gastrectomy generally contraindicates a Collis gastroplasty. Most patients with recurrent reflux esophagitis after a previous operation will require a thoracoabdominal Collis—Nissen operation. This operation is indicated whenever the esophagogastric junction cannot without tension be brought down to the level of the median arcuate ligament.