UNCUT COLLIS-NISSEN GASTROPLASTY - EARLY FUNCTIONAL RESULTS

Background. This study reviewed the short-term results of the uncut Co llis-Nissen gastroplasty. Methods. From 1990 through 1993, 27 consecut ive patients (16 men, 11 women) underwent an uncut Collis-Nissen gastr oplasty. Mean age was 59 years (range, 30 to 75 years). Three patients had a previous failed antireflux procedure. Indications for operation were gastroesophageal reflux disease resistant to medical treatment i n 18 patients and symptomatic hiatal hernia in 9 patients. Fourteen pa tients had Barrett's esophagus and 4 had a peptic stricture. Complete esophageal function testing including barium swallow, endoscopy, manom etry, and 24-hour pH recording was performed in 26 of 27 patients preo peratively and postoperatively. Results. Five patients (19%) had compl ications, which included atelectasis in 2, cardiac dysrhythmia in 2, a nd prolonged ileus in 1. There were no operative deaths. Follow-up was complete in all patients and ranged from 8 to 45 months (mean, 22 mon ths). Subjectively, symptoms of reflux were resolved in all patients. Six patients complain of slow esophageal emptying and 3 have occasiona l episodes of dysphagia. None required postoperative dilation. Ulcers and erosions healed in all 26 patients who underwent endoscopy but rec urred in 2 at 21 and 36 months postoperatively. Mean lower esophageal sphincter gradient increased from 8.3 mm Hg preoperatively to 14.6 mm Hg (p = 0.0001). Total percent of acid exposure decreased from 8.0% pr eoperatively to 1.7% (p = 0.003). Conclusions. We conclude that the un cut Collis-Nissen procedure provides acceptable short-term control of gastroesophageal reflux disease.