Long-term follow-up of peptic strictures managed by dilatation, modified Collis gastroplasty, and Belsey hiatus hernia repair

Abstract

Between 1964 and 1974, 277 patients with peptic esophagitis were managed by modified Collis gastroplasty and Belsey hiatus hernia repair. By adding a gastroplasty in patients with esophageal shortening, an antireflux repair can be done below the diaphragm, with elimination of tension on both the repair and the intrathoracic esophagus. Indications for repair in this series were peptic strictures, 102; recurrent hiatus hernia, 90; panmural esophagitis with stricture, 44; and reflux esophagitis associated with primary motor disorders, 41. Results of treatment are being evaluated by clinical history, esophagography, esophagoscopy and manometry; and generally they appear to be excellent. However, follow-up is too short in many of these patients to permit meaningful evaluation. A more critical analysis is provided by long-term follow-up of patients with the most severe pathology. This report reviews results in the 33 patients in the series, with peptic strictures, operated on more than 5 years ago. Five of the 33 patients died of unrelated disease before reaching their fifth year after operation, and two were lost to followup. Twenty-six patients have been followed 5 to 12 years since operation. Twenty-five patients had excellent results which were sustained during the period of follow-up. They take a regular diet without dysphagia, and none has symptomatic reflux. One patient, whose symptoms initially resolved, developed recurrent reflux due to peptic ulceration and pyloric stenosis. The functional results achieved with this operation are good and are maintained well beyond 5 years. Results reported with alternative, conservative operations for peptic stricture are reviewed.