Laparoscopic and left thoracoscopic Collis-Nissen procedure: technique and short term results]

The aim of this paper is to illustrate a laparoscopic-thoracoscopic technique for the surgical management of foreshortened esophagus in patients affected by severe gastro-esophageal reflux disease. The patient is placed on the operating table with the left chest and arm lifted to perform a thoracostomy in theV-VI space, posterior to the axillary line. The hiatus is opened and the distal esophagus is mobilized. With intraoperative endoscopy the position of the gastroesophageal junction in relationship to the hiatus is determined in order to decide whether to perform a standard procedure for reflux or to lengthen the esophagus. In the second case, short gastric vessels are divided and the gastric fundus is mobilized. An endostapler is introduced into the left chest. The Collis gastroplasty is performed over a 42 Maloney bougie. A floppy Nissen and the hiatoplasty complete the procedure. Twenty-two procedures of laparoscopic-thoracoscopic Collis gastroplasty were performed. The postoperative course was regular in 17 patients and complicated in 5 cases. Two procedures were converted for split of the endosuture caused by an oversized Maloney bougie (52 Ch). Other complications included intrathoracic migration of the fundoplication with need for repeating laparoscopic surgery, an empyema without fistula and atrial fibrillation. In conclusion, this technique corresponds to all principles of anti-reflux surgery and makes it possible to properly treat any anatomical condition.