Elongation gastroplasty with transverse fundoplasty: The Jeyasingham repair
Received 23 July 2008; received in revised form 7 October 2008; accepted 2 November 2008. published online 01 June 2009.
Objective
Surgical management of massive hernias and complex gastroesophageal reflux disease requires a tension-free repair with reliable reflux control. The aim of this observation was to evaluate the functional results of a modified Collis-Nissen gastroplasty with a transverse widening fundoplasty.
Methods
Between 1995 and 2007, 26 patients underwent a 3-cm cut elongation gastroplasty with a transverse widening of the fundus followed by a 3-cm total (n = 24) or partial (n = 2) fundoplication. Indications for the operation were symptomatic massive hiatal hernias (n = 4), hiatal hernias with Barrett's esophagus (n = 8), or correction of previously failed antireflux fundoplications (n = 14). Barrett's esophagus was documented in 19 of the 26 patients. Pre- and postoperative assessment included symptoms, barium swallow, endoscopy, manometry, and 24-hour pH monitoring.
Results
There was no postoperative mortality. Complications were recorded in 6 patients. Median follow-up was 105 months. Reflux symptoms present in all patients before the operation were found in 5 patients postoperatively (P < .001). Radiologic assessment documented an intact fundoplication in all patients. Lower esophageal sphincter gradient increased from a mean of 7.5 to 15 mm Hg (P = .003). Acid exposure (17% preoperatively) decreased significantly to 1% postoperatively (P < .001). Endoscopically, mucosal damage quantification decreased (3.1 preoperatively to 1.5 postoperatively; P < .001). All mucosal breaks healed but the columnar-lined metaplasia persisted.
Conclusions
This modified elongation gastroplasty provided a reliable repair for massive hernias, shortened Barrett's esophagus, and reoperations. The lower esophageal sphincter gradient was restored and remained stable. Reflux exposure was reduced, and acute mucosal damage disappeared. Columnar-lined metaplasia remained unchanged.
Department of Surgery, Université de Montréal, Division of Thoracic Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
Address for reprints: André Duranceau, MD, Division of Thoracic Surgery, Centre Hospitalier de l'Université de Montreal, Pavillon Lachapelle, Suite D-8051, 1560 rue Sherbrooke Est, Montreal, Québec, Canada H2L 4M1.
Supported by La Fondation de France (Paris) and by the Thoracic Surgery Research Foundation of Montreal.
ABSTRACT