Surgery for Short Esophagus with Stricture

Abstract

The surgical management of short esophagus with stricture has been simplified in recent years by the introduction of an eosphageal lengthening procedure (Collis gastroplasty) combined with antireflux maneuvers, such as the Belsey and Nissen operations. This report compares the experimental and clinical manometric findings after these procedures. After myectomy of the lower esophageal sphincter (LES) in the cat, three experimental groups were developed including Collis gastroplasty, Collis-Belsey and Collis-Nissen. Formation of a gastric tube did not provide protection against reflux while the Collis-Nissen procedure was more effective than the Collis-Belsey in raising pressures at the high pressure zone (HPZ) (26.0 ± 3.5 cm H₂O vs 15.0 ± 2.7) and in preventing reflux (pH 6.3 ± 0.5 vs 2.9 ± 0.04). Of 20 patients with short esophagus and stricture, 11 underwent a Collis-Belsey procedure and nine a Collis-Nissen. The latter procedure resulted in an HPZ of greater amplitude and length than the Collis-Belsey (18.7 ± 2.3 mm Hg vs 11.6 ± 1.7 and 3.9 ± 0.4 cm vs 2.4 ± 0.2). It also proved to be a more effective antireflux procedure, for no patient so treated had a positive pH reflux test after operation whereas after the Collis-Belsey procedure all but one patient had a positive pH reflux test. Short-term clinical results also support the superiority of the Collis-Nissen operation.