Name of the Procedure:

Esophageal Lengthening Procedure (Common names: Collis Gastroplasty, Wedge Gastroplasty)

Summary

An esophageal lengthening procedure, such as Collis gastroplasty or wedge gastroplasty, involves surgically extending the length of the esophagus. This is often done to restore adequate esophageal length when part of it has been shortened due to certain medical conditions.

Purpose

This procedure addresses conditions where the esophagus is too short, often resulting from severe gastroesophageal reflux disease (GERD), esophagitis, or previous surgery. The goal is to lengthen the esophagus to allow proper function and to reduce symptoms such as acid reflux and difficulty swallowing.

Indications

• Severe GERD unresponsive to medication
• Esophageal stricture or fibrous narrowing
• Barrett’s esophagus with inadequate esophageal length
• Prior surgeries that have shortened the esophagus
• Hiatal hernia with significant esophageal shortening

Preparation

• Patients are usually required to fast for at least 8 hours before surgery.
• Blood tests, imaging studies (such as esophagrams or endoscopy), and pre-anesthesia assessments may be needed.
• Medication adjustments might be necessary, particularly for blood thinners or medications that affect the stomach’s acid.

Procedure Description

1. The patient is placed under general anesthesia.
2. A laparoscopic or open surgical approach is used to access the esophagus and stomach.
3. In Collis gastroplasty, the surgeon uses a portion of the stomach to extend the esophagus.
4. In wedge gastroplasty, the stomach's fundus is folded and sutured to add length to the esophagus.
5. The newly lengthened esophagus is repositioned and secured in the correct anatomical position.
6. The surgical site is closed, and the patient is brought out of anesthesia.

Duration

The procedure typically takes about 2 to 4 hours.

Setting

Esophageal lengthening procedures are performed in a hospital setting, often in an operating room.

Personnel

• Surgeons specializing in gastrointestinal or thoracic surgery
• Anesthesiologists
• Surgical nurses and operating room technicians

Risks and Complications

• Infection
• Bleeding
• Injury to surrounding organs
• Difficulty swallowing (dysphagia)
• Leak at the surgical site
• Recurrent acid reflux

Benefits

• Relief from severe GERD symptoms
• Improved esophageal function
• Reduced risk of esophageal strictures
• Improved quality of life as early as a few weeks post-surgery

Recovery

• Initial hospitalization for 2-5 days
• Gradual reintroduction of diet starting with liquids and progressing to solids
• Avoid heavy lifting and strenuous activity for several weeks
• Follow-up appointments to monitor healing and function

Alternatives

• Medical management with proton pump inhibitors or H2 blockers
• Endoscopic procedures such as the Stretta procedure or TIF (Transoral Incisionless Fundoplication)
• Nissen fundoplication for patients without severe esophageal shortening

Patient Experience

• Some discomfort and pain post-surgery, managed with pain medications
• Temporary dietary restrictions and gradual return to normal eating
• Potential need for speech or swallowing therapy in some cases
• Support and guidance from medical team to ensure smooth recovery