Lessons Learned from a Continuous Series of 23 Collis Laparoscopic Interventions: Indications, Technique and Results

Introduction: One of the universally accepted technical steps in the surgery of hiatal hernia and/or gastroesophageal reflux is the abdominalization of the distal esophagus on which fundoplication is performed. In patients with short esophagus, abdominalization of the esophagus is sometimes unachievable despite extensive mediastinal dissection. A fundoplication performed under these conditions is very often doomed to failure most often by intrathoracic migration of the assembly. Collis gastroplasty, performed by laparoscopy, is the technique of choice in these patients.
Methods: This is a retrospective analysis of 23 patients operated on from a Collis intervention between January 2010 and April 2016. 19 women and 4 men, 63 years old (range: 40-79), with a body mass index (BMI) of 32 kg/m2 (range: 24-38). Three patients had an intrathoracic ascent of a previous laparoscopic Nissen fundoplication and the other 20 patients had a hiatal hernia of which: 17 type III, 2 type IV and 1 type II.
Technique: All patients were operated on "intent to treat laparoscopically". After extensive dissection of the lower mediastinum, the diagnosis of short esophagus was established (intraabdominal esophagus <2 cm.) And the decision of gastroplasty according to Collis decided intraoperatively. A simple raphie cruroplasty was associated in 7 patients, 16 patients had in addition to raphe a prosthetic reinforcement. 16 patients had an antireflux procedure (13 times a Toupet, 3 times a Nissen) and 7 times a gastric pexie on the anterior aspect of the abdomen.
Results: No conversion, intraoperative complication or mortality was observed in our series. In the immediate postoperative period, we observed intrathoracic ascent in a patient with Collis gastroplasty associated with Nissen fundoplication and prosthetic cruroplasty. We treated it by laparoscopy with partial resection of the ischemic fundus and transformation of Nissen into Toupet. This patient also had a strengthening of his prosthetic cruroplasty. Another patient developed postoperative dysphagia after endoscopic dilation.
22 patients had an average follow-up of 67 months (range: 107-32). One patient had a severe late complication, manifesting as dysphagia secondary to intraesophageal migration of the prosthesis associated with cruroplasty. It required a laparotomy to remove the prosthesis, suture the loss of substance in the neo-esophagus and provisional placement of a temporary esophageal stent. From a functional point of view, 13 patients are currently asymptomatic, 6 patients have dyspepsia and/or diarrhea and 3 have heartburn.
Conclusions: Laparoscopic Collis Gastroplasty is a safe, reproducible technique with satisfactory results.