TREATMENT OF PROBLEMATIC HIATAL-HERNIA AS SOCIATED WITH REFLUX ESOPHAGITIS BY COLLIS-NISSEN GASTROPLASTY FUNDOPLICATION - INDICATIONS, TECHNIQUES, RESULTS OF A SERIES OF 17 CASES

Hiatus hernia with reflux can be asymptomatic or can lead to severe, c omplicated esophagitis or even to metaplasia, dysplasia and carcinoma. Ideally all refluxing patients with esophagitis who are not easily an d completely controlled with medical therapy should undergo anti-reflu x surgery before complications such as ulcers, stricture or columnar m etaplasia (Barrett's esophagus) occur. When esophagitis is long-lastin g or severe, shortening of the esophagus is common. In such cases the esophagus must be ''lengthened'' before an anti-reflux procedure can b e performed safely. This is the Collis gastroplasty. We have performed 17 Collis-Nissen procedures over 5 years for complicated gastroesopha geal reflux disease (GERD). Results were good to excellent in 8 cases, satisfactory in 6 and poor in 3. We conclude that a complete preopera tive workup with esophagoscopy (and biopsies), 24-hour pH monitoring a nd esophageal manometry must be performed in all patients with complic ated GERD to allow the best operative procedure to be chosen (gastropl asty-fundoplication, resection or total duodenal diversion). The role of alkaline reflux is also discussed.