The Collis-Belsey Procedure

The addition of gastroplasty is an option in management for any antireflux operation (hiatal hernia repair) when it is anticipated that the repair alone may result in an unacceptable level of tension on the reconstruction. All of the conmionly used standard repairs restore a segment of distal esophagus to an intra-abdominal position (Nissen, Belsey, Hill, and Toupet). The normal esopliagogastric junction lies within the channel of the diaphragmatic: hiatus, and even these standard repairs must exaggerate the length of the intra-abdominal segment of esophagus and may be assumed to create some degree of tension. The primary indication for the addition of gastroplasty is that of acquired shortening because of mural scarring and vertical scar contracture in the wall of the esophagus, secondary to peptic esophagitis. This complication is a feature of an advanced stage of reflux esophagitis, which may include confluent ulceration of the distal squanious epithelium, peptic stricture, and acquired columnar-lined esophagus. Gross degrees of shortening are easily recognized from the barium radiograph, from endoscopic evaluation, and by the surgeon at the time of operation. Specific measurements of esophageal length can also he made at the time of esophageal manometry. A typical case is presented.