Laparoscopic Collis Gastroplasty and Nissen Fundoplication

Laparoscopy video case: an intrathoracic stomach is the end stage of a hiatal hernial diaphragm and has a very low incidence. Frequently the diagnosis is made incidentally by endoscopic or radiographic investigations. There could be no clinical symptoms, however an intrathoracic stomach could be life treating.

The short esophagus increases the difficulty and limits the effectiveness of laparoscopic Nissen fundoplication. In out experience, approximately 20-25% of esophagi judged by preoperative criteria to be foreshortened will, after dissection, be insufficiently long to allow 2 cm of esophagus to reside below the diaphragm without inferior distraction (i.e., tension free). Collis gastroplasty combined with Nissen fundoplication has become the standard approach for the creation of an intraabdominal neoesophagus and fundic wrap. The Collis gastroplasty, is a technique to lengthen the esophagus in order to relieve tension on an antireflux repair in patients with acquired esophageal shortening. The gastroplasty is performed by fashioning a tube from the lesser curve of the stomach in continuity with the distal esophagus. Once completed, the gastroplasty tube is dealt with as if it were the distal esophagus. The Collis gastroplasty may be used in conjunction with any number of antireflux procedures; however, the procedures most commonly used in association with the Collis gastroplasty are the Belsey Mark IV and the Nissen procedures.