Results of the Collis-Nissen gastroplasty in patients with Barrett's esophagus

Background. Barrett's esophagus (BE) is an advanced stage of gastroesophage al reflux disease. Medical treatment and standard antireflux operations sho w a high failure rate. An elongated gastroplasty, wrapped by a total fundop lication should provide a tension-free repair with adequate protection agai nst reflux. The aim of this study is to review the operative effects of a C ollis-Nissen gastroplasty to treat reflux in Barrett's esophagus. Methods. From January 1989 to December 1997, 45 patients with BE (38 men, 7 women) aged 53.5 years, underwent a Collis-Nissen gastroplasty. Mean follo w-up is 35.9 months (range, 6 to 110 months). Pre- and postoperative evalua tions included symptom assessment, esophagogram, endoscopy, manometry, 24-h our pH study, and esophageal emptying scintigrams. Results. There were no operative deaths. All reflux symptoms were controlle d. Acid reflux was significantly reduced (percent time exposure decreased f rom 10% to 1%) and lower esophageal sphincter (LES) pressure were restored to normal (LES gradient increased from 4 mm Hg to 11 mm Hg). LES incomplete relaxation was noted in 50% of patients postoperatively. Endoscopically, m ucosal damage from reflux healed but the columnar mucosa with intestinal me taplasia persisted. Conclusions. The Collis-Nissen gastroplasty, in patients with BE, controls reflux disease, its symptoms, and the mucosal damage associated with this c ondition. It restores the LES gradient but increases the resistance to bolu s transit. There is no regression of the abnormal mucosa despite reflux cen tral. (Ann Thorac Surg 1999;68:1014-21) (C) 1999 by The Society of Thoracic Surgeons.