An innovate antireflux operation, the combined Collis gastroplasty - Nissen fundoplication procedure, was developed by our Service to reduce the risk of recurrent gastroesophageal reflux which has been encountered after the more traditional operations. This procedure has been used by our Service for nearly 20 years in more than 900 patients. Laparoscopic antireflux surgery is now being offered to those patients with reflux which is poorly controlled by medical therapy, and who do not have associated complications such as esophageal stricture or relative shortening of the esophagus. This procedure, performed using a video laparoscope, involves five puncture wounds in the abdominal wall. A standard Nissen fundoplication is performed over a bougie.
Average hospital stay is two days, and patients are able to return to work in one week.
Similarly, laparoscopic esophagomyotomy is available for the treatment of achalasia. The operation, pioneered by UM's Mark B. Orringer, M.D., is an alternative to the more traditional methods of esophageal resection for cancer which involve opening both the chest and abdomen. In Orringer's procedure, the esophagus is removed through the diaphragmatic hiatus working through an upper abdominal incision and a cervical incision without opening the chest. Alimentary continuity is re-established by mobilizing the stomach through the posterior mediastinum in the original esophageal bed and anastomosing the gastric fundus to the cervical esophagus above the level of the clavicles. Avoidance of a thoracotomy minimizes postoperative morbidity, and the cervical esophagogastric anastomosis virtually eliminates the risk of mediastinitis from an anastomotic leak inherent with a traditional intrathoracic esophagogastric anastomosis.