Transabdominal Collis gastroplasty

A Collis gastroplasty is the most common esophageal-lengthening procedure performed with paraesophageal hernia repair. A large-caliber bougie is passed via the mouth into the stomach and placed along the lesser curvature. A surgical stapler is then used to create an incision from the angle of His parallel to the bougie. The stapling creates a tubularized proximal stomach that becomes a natural extension or elongation of the esophagus. As a result, the esophagogastric junction is extended into the abdomen for approximately 5 cm. In open laparotomy, a Collis gastroplasty is typically performed after creation of a circular defect in the stomach using an EEA stapler (panels A and B). In laparoscopic surgery, a Collis gastroplasty is performed with a wedge fundectomy, which permits vertical placement of the stapler parallel to the lesser curvature (panels C and D).