A Hill Gastropexy Combined with Nissen Fundoplication Appears Equivalent to a Collis Nissen in the Management of Short Esophagus
IntroductionA Collis gastroplasty combined with a Nissen fundoplication is commonly used when a shortened esophagus is encountered. An alternative combines intra abdominal fixation of the gastroesophageal junction via a Hill gastropexy with a Nissen fundoplication to maintain length and avoid juxtaposing acid secreting tissue against the diseased esophagus.MethodsA retrospective case controlled analysis of 106 consecutive patients with short esophagus undergoing Hill Nissen (HN) or Collis Nissen (CN) was compared to a cohort of 105 matched patients without short esophagus undergoing primary Nissen fundoplication (NF).ResultsAt a median follow up of 27 months, all groups (HN:CN:NF) improved significantly over preoperative baseline with no differences in overall complications (18 vs 16 vs 19% p 0.78) DeMeester score (11.1 vs 19.1 vs 14.2, p 0.49) postoperative PPI use (16 vs 22 vs 15% p 0.24) anatomic recurrences (11.7 vs 5.5 vs 7% p 0.43) or quality of life (6.8 vs 6.7 vs 6.4, p 0.3).ConclusionsThe management of shortened esophagus with Hill Nissen is safe and as effective as Collis gastroplasty with Nissen fundoplication. Both options appear to produce similar outcomes to patients requiring only a Nissen fundoplication suggesting a shortened esophagus does not beget an inferior outcome.
Journal of Gastrointestinal Surgery