TREATMENT OF ADVANCED GASTROESOPHAGEAL REFLUX DISEASE WITH COLLIS GASTROPLASTY AND BELSEY PARTIAL FUNDOPLICATION

Objective: To examine the factors affecting outcome In patients with a dvanced gastroesophageal reflux disease. Design: Retrospective analysi s. Setting: University tertiary referral center. Patients: Thirty-seve n patients with advanced gastroesophageal reflux disease and no previo us antireflux surgery. Interventions: Thirty patients underwent Collis gastroplasty for esophageal lengthening and Belsey partial fundoplica tion. Seven patients with esophageal stricture and global loss of esop hageal body motility who underwent primary esophagectomy and reconstru ction were used as a comparison group. Outcome Measures: Symptomatic o utcome in all 37 patients was assessed by questionnaire at a median of 25 months (range, 5-156 months) after surgery. In-a subset of 11 pati ents undergoing the Collis-Belsey procedure, outcome was measured usin g 24-hour pH and results of motility studies. Results: The Collis-Bels ey procedure was successful in relieving symptoms of gastroesophageal reflux in 21 (70%) of the 30 patients. The outcome was excellent or go od in 16 (89%) of 18 patients who presented with symptoms other than d ysphagia, but only in 5 (42%) of 12 patients with dysphagia (P =.01). The outcome was particularly poor if dysphagia was associated with a p reviously dilated esophageal stricture. Persistent or induced dysphagi a was the reason for failure in all but 1 patient. Results of 24-hour esophageal pH studies were returned to normal in 8 (73%) of 11 patient s undergoing postoperative evaluation. Contraction amplitudes in the d istal esophagus and the prevalence of simultaneous contractions in the se segments did not change after the operation. All 7 patients who und erwent primary esophagectomy were classified as having an excellent or good outcome and were relieved of their reflux symptoms, including dy sphagia. Six of these could eat 3 meals per day and enjoyed an unrestr icted diet. Conclusions: The outcome of the Collis-Belsey procedure in patients with advanced gastroesophageal reflux disease without dyspha gia is excellent. It is less so in patients with dysphagia as a preope rative symptom. Esophagectomy can provide a good outcome in patients w ho have a combination of dysphagia stricture and a profound loss of es ophageal motility.