Objectives Foreshortened esophagus is one of the problems of the actual mini-invasive antireflux surgical therapy for GERD. The intrathoracic position of the g-e-junction in upright can be documented by a careful radiological study of the upper digestive tract, however, the reducibility of an adequate segment of esophagus below the diaphragm without tension can be assessed only intraoperatively, depending upon the severity of panmural esophagitis. Aim of this video is to illustrate a laparoscopic-thoracoscopic technique for the surgical management of complex cases of GERD. Methods When there is the possibility to adopt the Collis gastroplasty to elongate the esophagus, the patient is placed on the operating table in standard position for laparoscopy, with the left chest and arm lifted up to eventually perform a thoracostomy in the V–VI space, posterior axillary line. The hiatus is opened and the distal esophagus is extensively orad and circularly mobilized. With intraoperative endoscopy the relationship between g-e-junction and hiatus is determined. If the Collis procedure is required, the short gastric vessels are divided and the gastric fundus mobilized. An endostapler is introduced into the left chest blindly. The stapler’s tip pointed to the diaphragm gently walks on the diaphragm under laparoscopic vision and enters the lower mediastinum after trespassing the left pleura. The Collis gastroplasty is performed over a 42 Maloney bougie A floppy Nissen and the hiatoplasty complete the procedure. Results 12 procedures were performed. 3 were converted, 2 for split of the endosuture caused by an oversized Maloney bougie (52 Ch). After adopting the 46 Ch no complications occurred. In another case conversion was necessary in order to safely isolate the g-e-junction. Shortterms results are satisfactory in all cases. Conclusions This technique rationally and technically corresponds to all principles of antireflux surgery. It is well feasible.

The laparoscopic, left thoracoscopic Collis-Nissen procedure for the surgical treatment of short esophagus.

MATTIOLI, SANDRO;DI SIMONE, MASSIMO PIERLUIGI;LUGARESI, MARIALUISA;
2004

Abstract

Objectives Foreshortened esophagus is one of the problems of the actual mini-invasive antireflux surgical therapy for GERD. The intrathoracic position of the g-e-junction in upright can be documented by a careful radiological study of the upper digestive tract, however, the reducibility of an adequate segment of esophagus below the diaphragm without tension can be assessed only intraoperatively, depending upon the severity of panmural esophagitis. Aim of this video is to illustrate a laparoscopic-thoracoscopic technique for the surgical management of complex cases of GERD. Methods When there is the possibility to adopt the Collis gastroplasty to elongate the esophagus, the patient is placed on the operating table in standard position for laparoscopy, with the left chest and arm lifted up to eventually perform a thoracostomy in the V–VI space, posterior axillary line. The hiatus is opened and the distal esophagus is extensively orad and circularly mobilized. With intraoperative endoscopy the relationship between g-e-junction and hiatus is determined. If the Collis procedure is required, the short gastric vessels are divided and the gastric fundus mobilized. An endostapler is introduced into the left chest blindly. The stapler’s tip pointed to the diaphragm gently walks on the diaphragm under laparoscopic vision and enters the lower mediastinum after trespassing the left pleura. The Collis gastroplasty is performed over a 42 Maloney bougie A floppy Nissen and the hiatoplasty complete the procedure. Results 12 procedures were performed. 3 were converted, 2 for split of the endosuture caused by an oversized Maloney bougie (52 Ch). After adopting the 46 Ch no complications occurred. In another case conversion was necessary in order to safely isolate the g-e-junction. Shortterms results are satisfactory in all cases. Conclusions This technique rationally and technically corresponds to all principles of antireflux surgery. It is well feasible.
2004
MATTIOLI S.; DI SIMONE M.P.; D’OVIDIO F.; LUGARESI M.L.; FERRUZZI L.; PILOTTI V.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/15127
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