Three-dimensional computed tomography reconstruction of the gastroesophageal junction following hiatal hernia repair with Collis gastroplasty and fundoplication: a novel method to demonstrate postoperative morphology and better understand hiatal hernia recurrence

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BACKGROUND: Collis gastroplasty for esophageal lengthening is a complex adjunct to hiatal hernia repair in patients with esophageal foreshortening. AIMS: To study the final morphology of the repair using state-of-the-art imaging: computed tomography with three-dimensional reconstruction. METHODS: Nine patients with prior Collis gastroplasty and hiatal hernia repair were studied with three-dimensional computed tomography reconstruction to evaluate the anatomy of the repair and screen for hiatal hernia recurrence. Secondary outcomes were quality of life and surgical morbidity. RESULTS: After a medium follow-up of 34 months, objective recurrence of the hiatal hernia was observed in three patients (1.5, 2.2, and 3 cm), and two patients were symptomatic. The gastroesophageal junction tube (neo-esophagus) created by the gastroplasty was similar in shape and volume to the native esophagus in all patients. The fundoplication previously performed covered the neo-esophagus in only two of the nine patients. No fistulas or mortality were observed. CONCLUSIONS: Three-dimensional computed tomography reconstruction of the gastroesophageal junction following hiatal hernia repair with Collis gastroplasty and fundoplication reliably demonstrates postoperative anatomy and helps better understand hiatal hernia recurrence.