Collis Gastroplasty

    Gastroplasty is an oesophageal lengthening technique that is designed to relieve any tension that an anti reflux procedure may cause. Mural scarring and peptic oesophagitis, and systemic sclerosis remain the most common causes of oesophageal shortening.

Pre operative investigations

Contrast radiography - The failure to reduce a sliding hernia while in an upright position may indicate a short opesophagus.

Oesophagoscopy - The finding of  a high OG junction +/- peptic oesphagitis

Oesophageal manometry - Abnormal high postion of the lower oesophageal sphincter may be deomonstrated.

A PRECISE JUDGEMENT OF OESOPHAGEAL SHORTENING IS ONLY GAINED WITH EXPERIENCE.

Operation

A left postero-lateral thoracotomy through t the 6th rib space is performed (an abdominal approach can also be utilised).

The resultant exposure

The oesophagus is slung

The fat pad needs mobilising and removing

The vagus nerve is identified and preserved

A 48 Fr Maloney bougie is passed across the oesophago-gastric junction. A new approximately 5cm gastric tube is created with the stapler

Gastric tube creation with a GIA stapler

The stapled edge is over sewn, and the corner of the stomach is inverted to eliminate the dog ear

A 270 degree partial fundoplication is then performed

A Belsey spoon is utilised to finish the fundolpication