Long term Results of the Thoracoscopic Collis-Laparoscopic Nissen for the Treatment of severe GERD with Acquired Short Esophagus..

Background: Purpose of this study is to present the long term results of the thoracoscopic Collis laparoscopic Nissen performed for the treatment of severe GERD associated with short esophagus. Methods: GERD patients were assessed before surgery with interview based on semi-quantitative scales for grading of symptoms, esophagitis from 0 (no symptoms and esophagitis) to 3 (severe symptoms and esophagitis), global evaluation (excellent, good, fair, insuffi cient), endoscopy hysthology, barium swallow, manometry; after surgery every year, alternating interview and tests (same questionnaires as above) except routine manometry, according to a protocol. Intraoperatively the length of the addominal esophagus after maximal mediastinal mobilization of the esophagus was measured with a validated technique; true short esophagus was diagnosed when the submerged segment was 1.5 cm. After surgery, result in patients receiving medical therapy or with recurrent hernia, although asymptomatic, was classifi ed as insuffi cient. Results: From 1996 to 2011, 299 minimally invasive procedures for GERD were performed. In 62/299 (20.7 %) short esophagus was assessed. The left thoracoscopic Collis gastroplasty was associated with 1 Toupet and 1 Dor (motility disorders), with the Nissen fl oppy fundusplication in 60 patients (24 women, 36 men, mean age 55.2 13.7 years, range 20 - 77). 5 procedures were converted at the beginning of the experience. Mortality was 1.7% (1/60), morbidity 11.7% (7/60). The mean follow-up was 58.6 32.1 months (range 12–108). Discussion: With the thoracoscopic Collis-laparoscopic Nissen in patients affected by severe GERD and true short esophagus , satisfactory long-term results were achieved in 93.4% of cases. Disclosure: All authors have declared no confl icts of interest.