The problems encountered with the "short esophagus" in laparoscopic antireflux surgery

Introduction: Esophageal shortening as a complication of advanced gastroesophageal reflux disease is seen in 2-4 % of patients with GERD. For such patients undergoing laparoscopic antireflux surgery, the procedure is doomed to failure because of excessive tension. As a consequence, recurrent hiatal hernia or thoracic placement of the fundoplication with unfavorable functional results can occur. Methods: The Collis gastroplasty as an esophageal lengthening procedure was first described by Collis in 1957. Collis gastroplasty combined with Nissen fundoplication produces an intraabdominal neoesophagus with a fundic wrap. Results: We performed 255 laparoscopic antireflux procedures between March 1994 and February 2000. We report on five patients (2.0 %) with a shortened esophagus treated with Collis gastroplasty and Nissen fundoplication. On follow-up, all patients showed symptomatic relief from reflux symptoms, especially from dysphagia. Conclusion: The Collis gastroplasty combined with Nissen fundoplication is an effective procedure in patients with shortened esophagus diagnosed intraoperatively during laparoscopic antireflux surgery. Because of neoesophageal acid production proximal to an intact fundoplication coupled with poor esophageal clearance, there was no complete restitution.