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Collis fundoplication

Jessica A Zaman, Anne O Lidor
While the asymptomatic paraesophageal hernia (PEH) can be observed safely, surgery is indicated for symptomatic hernias. Laparoscopic repair is associated with decreased morbidity and mortality; however, it is associated with a higher rate of radiologic recurrence when compared with the open approach. Though a majority of patients experience good symptomatic relief from laparoscopic repair, strict adherence to good technique is critical to minimize recurrence. The fundamental steps of laparoscopic PEH repair include adequate mediastinal mobilization of the esophagus, tension-free approximation of the diaphragmatic crura, and gastric fundoplication...
October 2016: Current Gastroenterology Reports
Sandro Mattioli, Marialuisa Lugaresi, Alberto Ruffato, Niccolò Daddi, Massimo Pierluigi Di Simone, Ottorino Perrone, Stefano Brusori
The Collis-Nissen procedure is performed for the surgical treatment of 'true short oesophagus'. When this condition is strongly suspected radiologically, the patient is placed in the 45° left lateral position on the operating table with the left chest and arm lifted to perform a thoracostomy in the V-VI space, posterior to the axillary line. The hiatus is opened and the distal oesophagus is widely mobilized. With intraoperative endoscopy, the position of the oesophago-gastric junction in relationship to the hiatus is determined and the measurement of the length of the intra-abdominal oesophagus is performed to decide either to carry out a standard anti-reflux procedure or to lengthen the oesophagus...
2015: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Marialuisa Lugaresi, Benedetta Mattioli, Niccolò Daddi, Massimo Pierluigi Di Simone, Ottorino Perrone, Sandro Mattioli
OBJECTIVES: Type III-IV hiatal hernia (HH) is associated with a true short oesophagus in more than 50% of cases; dedicated treatment of this condition might be appropriate to reduce the recurrence rate after surgery. A case series of patients receiving surgery for Type III-IV hernia was examined for short oesophagus, and the results were analysed. METHODS: From 1980 to 1994, 60 patients underwent an open surgical approach, and the position of the oesophago-gastric junction was visually localized; from 1995 to 2013, 48 patients underwent a minimally invasive approach, and the oesophago-gastric junction was objectively localized using a laparoscopic-endoscopic method...
April 2016: European Journal of Cardio-thoracic Surgery
Rym El Khoury, Mauricio Ramirez, Eric S Hungness, Nathaniel J Soper, Marco G Patti
BACKGROUND: Laparoscopic repair of paraesophageal hernia (LPEHR) is considered today the standard of care for this condition. While attention has been mostly focused on the incidence of postoperative radiologic recurrence of a hiatal hernia, few data are available about the effect of the operation on symptoms. AIMS: In this study, we aim to determine the effect of primary LPEHR on postoperative symptoms. PATIENTS AND METHODS: One hundred and sixty-two patients underwent LPEH repair in two academic tertiary care centers...
November 2015: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
S R Yamamoto, S Akimoto, M Hoshino, S K Mittal
The aim of this study was to investigate high-resolution manometry (HRM) findings in symptomatic post-fundoplication patients with normal endoscopic configuration. A retrospective review of a prospectively maintained database was conducted to identify patients who underwent evaluation with HRM and endoscopy for symptom evaluation after previous fundoplication. Study period extends from September 2008 to December 2012. Only patients with complete 360° fundoplication (Nissen) were included, and patients with partial fundoplication were excluded...
July 30, 2015: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
Nicholas R Kunio, James P Dolan, John G Hunter
In the presence of long-standing and severe gastroesophageal reflux disease, patients can develop various complications, including a shortened esophagus. Standard preoperative testing in these patients should include endoscopy, esophagography, and manometry, whereas the objective diagnosis of a short esophagus must be made intraoperatively following adequate mediastinal mobilization. If left untreated, it is a contributing factor to the high recurrence rate following fundoplications or repair of large hiatal hernias...
June 2015: Surgical Clinics of North America
Marcin Migaczewski, Anna Zub-Pokrowiecka, Agata Grzesiak-Kuik, Michał Pędziwiatr, Piotr Major, Mateusz Rubinkiewicz, Marek Winiarski, Michał Natkaniec, Andrzej Budzyński
INTRODUCTION: The last two decades have observed development of surgical treatment of benign conditions of the gastroesophageal junction (GEJ), including anti-reflux surgery, due to the growing popularity of the laparoscopic approach. Migration of the fundoplication band and recurrent hiatal hernia are a result of the lack of correct diagnosis and appropriate management of the so-called short esophagus. According to various authors, short esophagus is present in up to 60% of patients qualified for anti-reflux surgery...
April 2015: Wideochirurgia i Inne Techniki Mało Inwazyjne, Videosurgery and Other Miniinvasive Techniques
Joshua Shroll, Maged Guirguis, Ajay D'Mello, Thomas Mroz, Jia Lin, Ehab Farag
We present a case of massive spinal epidural hematoma with an atypical presentation characterized by unilateral, isolated motor deficit in the right lower extremity on postoperative day 2 after Collis-Nissen fundoplication and a T7-8 epidural for postoperative pain. The epidural had been placed in the preoperative theater before surgery. Subcutaneous unfractionated heparin was initiated 18 hours later on postoperative day 1 with 3 times daily dosing. The patient also received 3 doses of ketorolac starting 10 hours after epidural placement...
April 1, 2014: A & A Case Reports
Leonardo Emilio da Silva, Maxley M Alves, Tanous Kalil El-Ajouz, Paula C P Ribeiro, Ruy J Cruz
BACKGROUND: Some studies have recently suggested that laparoscopic sleeve gastrectomy may exacerbate gastroesophageal reflux disease (GERD) symptoms or even increase the risk of "de novo" post-operative GERD. We herein describe and evaluate the initial response of an alternative technique of sleeve gastroplasty combined with Nissen fundoplication for morbidly obese patients who present significant GERD. METHODS: From January 2008 to December 2013, 122 morbidly obese patients underwent laparoscopic Sleeve-Collis-Nissen gastroplasty (LSCNG)...
July 2015: Obesity Surgery
Jennifer L Wilson, Daniel Davila Bradley, Brian E Louie, Ralph W Aye, Eric Vallières, Alexander S Farivar
Axial shortening of the esophagus is caused by repetitive esophageal injury from gastroesophageal reflux disease resulting in esophagitis, submucosal fibrosis, and esophageal dysmotility. A short esophagus (<2 cm of intraabdominal length after type II mediastinal dissection) is encountered in 20% to 63% of patients undergoing paraesophageal hernia repair. An esophageal lengthening procedure can be a useful adjunct to fundoplication to reduce the 50% recurrence rate reported at 5 years. We describe a simplified Collis gastroplasty technique that negates the need for wedge fundectomy, potentially saving operating room time and cost, while hypothetically reducing morbidity...
November 2014: Annals of Thoracic Surgery
Michael Latzko, Frank Borao, Anthony Squillaro, Jonas Mansson, William Barker, Thomas Baker
BACKGROUND AND OBJECTIVES: Laparoscopy has quickly become the standard surgical approach to repair paraesophageal hernias. Although many centers routinely perform this procedure, relatively high recurrence rates have led many surgeons to question this approach. We sought to evaluate outcomes in our cohort of patients with an emphasis on recurrence rates and symptom improvement and their correlation with true radiologic recurrence seen on contrast imaging. METHODS: We retrospectively identified 126 consecutive patients who underwent laparoscopic repair of a large paraesophageal hernia between 2000 and 2010...
July 2014: JSLS: Journal of the Society of Laparoendoscopic Surgeons
Rachel Jones, Carl Tadaki, Dmitry Oleynikov
Esophageal shortening can be seen in patients with chronic inflammation associated with gastroesophageal reflux disease and paraesophageal hernias. During surgical treatment of these conditions, it is important to address the esophageal shortening during the operation for optimal outcomes. Ideally, 2.5-3 cm of tension-free intraabdominal esophagus is recommended. During this video, we show a redo paraesophageal hernia repair in which we were unable to achieve adequate esophageal lengthening despite extensive mediastinal dissection...
March 2015: Surgical Endoscopy
Evan T Alicuben, Stephanie G Worrell, Steven R DeMeester
The use of mesh to reinforce crural closure during hiatal hernia repair is controversial. Although some studies suggest that using synthetic mesh can reduce recurrence, synthetic mesh can erode into the esophagus and in our opinion should be avoided. Studies with absorbable or biologic mesh have not proven to be of benefit for recurrence. The aim of this study was to evaluate the outcome of hiatal hernia repair with modern resorbable biosynthetic mesh in combination with adjunct tension reduction techniques...
October 2014: American Surgeon
Evan T Alicuben, Stephanie G Worrell, Steven R DeMeester
BACKGROUND: Hernia recurrence is the leading form of failure after antireflux surgery and may be secondary to unrecognized tension on the crural repair or from a foreshortened esophagus. Mesh reinforcement has proven beneficial for repair of hernias at other sites, but the use of mesh at the hiatus remains controversial. The aim of this study was to evaluate the outcomes of hiatal hernia repair with human dermal mesh reinforcement of the crural closure in combination with tension reduction techniques when necessary...
November 2014: Journal of the American College of Surgeons
Milos Bjelović, Tamara Babic, Dragan Gunjić, Milan Veselinović, Bratislav Spica
INTRODUCTION: Repair of hiatal hernias has been performed traditionally via open laparotomy or thoracotomy. Since first laparoscopic hiatal hernia repair in 1992, this method had a growing popularity and today it is the standard approach in experienced centers specialized for minimally invasive surgery. OBJECTIVE: In the current study we present our experience after 200 consecutive laparoscopic hiatal hernia repairs. METHODS: A retrospective cohort study included 200 patients who underwent elective laparoscopic hiatal hernia repair at the Department for Minimally Invasive Upper Digestive Surgery, Clinic for Digestive Surgery, Clinical Center of Serbia in Belgrade from April 2004 to December 2013...
July 2014: Srpski Arhiv za Celokupno Lekarstvo
D M Bunting, L Szczebiot, P M Peyser
INTRODUCTION: The benefits of antireflux surgery are well established. Laparoscopic techniques have been shown to be generally safe and effective. The aim of this paper was to review the subject of pain following laparoscopic antireflux surgery. METHODS: A systematic review of the literature was conducted using the PubMed database to identify all studies reporting pain after laparoscopic antireflux surgery. Publications were included for the main analysis if they contained at least 30 patients...
March 2014: Annals of the Royal College of Surgeons of England
Kazuto Tsuboi, Nobuo Omura, Fumiaki Yano, Masato Hoshino, Se Ryung Yamamoto, Shunsuke Akimoto, Hideyuki Kashiwagi, Katsuhiko Yanaga
We herein report our technique for laparoscopic esophageal myotomy combined with Collis gastroplasty and Nissen fundoplication for severe esophageal stenosis. Our patient had experienced vomiting since childhood, and his dysphagia had gradually worsened. He was referred to our department for surgery because of resistance to pneumatic dilation. He was diagnosed with a short esophagus based on the findings of a preoperative upper gastrointestinal series and GI endoscopy. After exposing the abdominal esophagus, esophageal myotomy around the esophago-gastric junction (EGJ) was undertaken to introduce an esophageal bougie into the stomach...
February 2015: Surgery Today
Jörg Zehetner, Steven R DeMeester, Shahin Ayazi, Patrick Kilday, Evan T Alicuben, Tom R DeMeester
OBJECTIVE: To assess the outcome of a laparoscopic wedge-fundectomy Collis gastroplasty for a short esophagus during fundoplication and hiatal hernia repair. BACKGROUND: The Collis gastroplasty provides a surgical solution for a foreshortened esophagus but has been associated with postoperative dysphagia and esophagitis. METHODS: We identified 150 patients who underwent a Collis gastroplasty from 1998 to 2012, and of these, 85 patients underwent laparoscopic procedures using the wedge-fundectomy technique...
December 2014: Annals of Surgery
Kiyokazu Nakajima, Tsuyoshi Takahashi, Shuji Takiguchi, Hiroshi Miyata, Makoto Yamasaki, Yukinori Kurokawa, Masaki Mori, Yuichiro Doki
A 51-year-old female with esophageal stricture was referred to our hospital. She was diagnosed to have mixed connective tissue disease and had been placed on steroid and immunosuppressant treatment. She presented with passage disturbance and free reflux of the gastric contents when in the supine position. Pneumatic dilatation and medication resulted in partial relief of her symptoms. Preoperative imaging studies demonstrated a shortened esophagus with severe stricture of the esophagogastric junction and a moderate hiatal hernia...
November 2013: Surgery Today
Steven R DeMeester
INTRODUCTION: Laparoscopic repair of paraesophageal hernias (PEH) is associated with a high objective hernia recurrence rate. Tension is a key factor in the repair of any hernia, and tension is a cause for hernia recurrence. METHODS: This is a review of my current technique for PEH repair, and represents the culmination of years of experience and modifications in an effort to minimize objective hernia recurrence rates in my own practice. RESULTS: There are 4 critical steps that must be part of every PEH repair in my opinion...
October 2013: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
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