Left Thoracic-Laparoscopic Collis-Nissen Antireflux Procedure for the surgical treatment of Gastro-Oesophageal Reflux

Objective: To assess the medium term results of the thoracic-laparoscopic Collis-Nissen antireflux procedure. Methods: Between 2001 and 2006, over a total of 164 antireflux procedures, 41 patients, 25 male (60,97%) and 16 female (39%), average age 55 years old (range 28-76), underwent thoracic-laparoscopic Collis-Nissen technique. According to barium swallow, 11 patients (26.8%) had hiatal insufficiency, seven patients (17%) had concentric hiatus hernia, ten patients (24.39%) had short oesophagus and 13 patients (31.7%) had massive incarcerated hiatus hernia. The Collis gastroplasty was performed if, after a wide mobilization of the distal oesophagus (mean: 8.1 cm; range: 4-12 cm), the distance between the gastric folds (intraoperative endoscopy) and the apex of the hiatus was ≤1.5 cm (in obese and young patients ≤2 cm) without applying any pull on the stomach. All patients were periodically controlled with clinical interview, UGI tract endoscopy and barium swallow. The clinical results were graded according to reflux symptoms (RS), dysphagia (D), oesophagitis (OE): excellent (RS0, D0, OE0), good (RS1, D1, OE0), fair (RS1-2, D2, OE1) and poor (RS2-3, D2-3, OE 2-3). Results: Three patients (7.3%) were converted into laparotomy. Postoperative course was regular in 85.3% of cases, one patient (2.4%) died for Collis fistula, one patient (2.4%) had empyema without fistula, one patient (2.4%) had partial intrathoracic migration of the gastroplasty and was reoperated upon five days after. Mean follow-up was 29.45 months. Clinical results were excellent in 39%, good in 48.7% and poor in 12.1%. Conclusions: Thoracic-laparoscopic Collis-Nissen seems to be a good option for the surgical treatment of severe GERD complicated with the foreshortening of the oesophagus. The definitive evaluation of the procedure will withstand the trial of time.