Uncut Collis-Nissen fundoplication: Learning curve and long-term results

Background. Between September 1985 and July 1990, the first 100 consecutive patients (50 female and 50 male) undergoing primary uncut Collis-Nissen fu ndoplication performed by one surgeon were reviewed. Methods. Median age was 62 years and ranged from 19 to 89 years. Indication s for repair included gastroesophageal reflux in 56 patients, obstructive s ymptoms in 34, and a combination of both in 10. An upper gastrointestinal e ndoscopy was performed in 99 patients; all were abnormal. Esophagitis was d ocumented in 53 patients, large diaphragmatic hernia in 36, stenosis in 18, "Cameron's erosions" in 17, Barrett's disease in 13, and other findings in 9 patients. An abnormal upper gastrointestinal series was demonstrated in 96 of 97 patients evaluated. Motility studies were performed in 95 patients , and 11 had abnormal peristalsis. All procedures were performed through a left thoracotomy. Results. Complications occurred in 23 patients and included respiratory fai lure in 6, atrial fibrillation in 3, atelectasis in 3, pneumonia in 2, myoc ardial infarction in 2,and chylothorax, severe dysphagia, early breakdown o f repair, cardiac tamponade, hematuria, spinal headache, and intraoperative perforation by dilator in 1 each. There were 2 postoperative deaths, both cardiac in origin. Median hospitalization was 8 days (range, 6 to 76 days). The first 25 patients had 10 complications (40%) and 2 deaths (8%). The re maining 75 patients had 13 complications (17%) and no deaths (mortality, p = 0.06; morbidity, p = 0.03). Follow-up was complete in all patients for a median of 100 months (range, 3 to 138 months). Eighty-six of the 98 operati ve survivors are currently alive. At last follow-up, excellent functional r esults were observed in 58 patients (59%), good in 24 (25%), fair in 8 (8%) , poor in 7 (7%), and unknown in 1 (1%). Conclusion. We conclude that the uncut Collis-Nissen fundoplication provide s good to excellent long-term results in 84% of patients. Operative mortali ty and morbidity is acceptable but is associated with a learning curve. (C) 1998 by The Society of Thoracic Surgeons.