Benign Esophageal Disease: Gastroesophageal Reflux &
Hiatal Hernia, Achalasia, Esophageal Diverticula
The University of Michigan General Thoracic Surgery Service has one of the largest esophageal surgery programs in the United States, performing 150-200 major operations per year for the treatment of gastroesophageal reflux and its complications, neuromotor esophageal dysfunction (achalasia, diverticula), and tumors. Timely and thorough evaluation in our esophageal function laboratory (providing esophageal manometry and intraesophageal pH reflux testing), as well as with both flexible and rigid esophagoscopy, are available. 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 30 years. The results of this operation have been published, and long-term control of reflux and esophagitis has been documented in more than 90% of patients undergoing primary repair of their hiatal hernias.
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. Although long-term results are not yet available, short-term effects are comparable to those reported for more traditional approaches.
