Long-term results of the Thoracoscopic Collis-Laparoscopic Nissen for the treatment of severe Gastro-Oesophageal reflux with Acquired Short Esophagus.

Objectives: The purpose of this study is to present the long-term results of thoracoscopic Collis and laparoscopic Nissen performed for the treatment of severe GERD associated with short oesophagus. Methods: GERD patients were assessed before surgery with interview based on semi-quantitative scales for grading of symptoms and oesophagitis from 0 (no symptoms and oesophagitis) to 3 (severe symptoms and oesophagitis), global evaluation (excellent, good, fair, insufficient), endoscopy + histology, 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 abdominal oesophagus after maximal mediastinal mobilization of the oesophagus was measured with a validated technique; true short oesophagus 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 classified as insufficient. Results: From 1996 to 2011, 299 minimally invasive procedures for GERD were performed. In 62/299 (20.7%) short oesophagus was assessed. The left thoracoscopic Collis gastroplasty was associated with 1 Toupet and 1 Dor (motility disorders), with the Nissen floppy fundoplication in 60 patients (24 women, 36 men, mean age 55.2±13.7 years, range 20–77). Five 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). Conclusions: With the thoracoscopic Collis-laparoscopic Nissen in patients affected by severe GERD and true short oesophagus, satisfactory long-term results were achieved in 93.4% of cases. Disclosure: All authors have declared no conflicts of interest.