JTCS Click here to go to SJM website.
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Jocelyne Martin
Pasquale Ferraro
André Duranceau
Right arrow Permission Requests
Google Scholar
Right arrow Articles by D'Journo, X. B.
Right arrow Articles by Duranceau, A.
PubMed
Right arrow Articles by D'Journo, X. B.
Right arrow Articles by Duranceau, A.
Related Collections
Right arrow Esophagus - other

J Thorac Cardiovasc Surg 2009;138:1192-1199
© 2009 The American Association for Thoracic Surgery

General Thoracic Surgery

Elongation gastroplasty with transverse fundoplasty: The Jeyasingham repair

Xavier Benoit D'Journo, MD, Jocelyne Martin, MD, Soufiane Bensaidane, MD, Pasquale Ferraro, MD, André Duranceau, MD*

Department of Surgery, Université de Montréal, Division of Thoracic Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada

Received for publication July 23, 2008; revisions received October 7, 2008; accepted for publication November 2, 2008.

* 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. (Email: andre.duranceau{at}umontreal.ca).

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.

Acronym and Abbreviation LES = lower esophageal sphincter






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2009 by The American Association for Thoracic Surgery.