Transthoracic Gastroplasty (Collis) and Nissen Fundoplication
As discussed in the previous chapters (see esp. Chap. 66), this operation is indicated in patients with reflux esophagitis that has caused a significant degree of fibrosis, constriction, and shortening of the esophagus. In some patients without much esophageal shortening, advanced fibrosis itself will interfere with the antireflux efficiency of a fundoplication because the rigid esophageal walls will not be compressed by the fundoplication. For this reason, Pearson and Henderson; Urschel, Razzuk, Wood, Galbraith et al.; and Orringer and colleagues (see Chap. 66) believe that almost every esophageal stricture caused by reflux should be treated by a Collis gastroplasty and an antireflux procedure. A previous high subtotal gastrectomy generally contraindicates a Collis gastroplasty. Most patients with recurrent reflux esophagitis after a previous operation will require a thoracoabdominal Collis—Nissen operation. This operation is indicated whenever the esophagogastric junction cannot without tension be brought down to the level of the median arcuate ligament.
KeywordsVagus Nerve Staple Line Esophagogastric Junction Proximal Stomach Left Gastric Artery
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