June 27, 2023
Montcusi B, Jaume-Bottcher S, Alvarez I, et al. 5-Year Collis-Nissen Gastroplasty Outcomes for Type III-IV Hiatal Hernia with Short Esophagus. J Am Coll Surg. 2023, in press.
Laparoscopic Nissen fundoplication is the most common surgical procedure performed for treatment of gastroesophageal reflux caused by Type III-IV hiatal hernia. Recurrence of the hiatal hernia is detected during long-term follow up (up to 5 years) in up to 66% of patients who have barium meal radiologic examinations.
Short esophagus (<2.5 cm abdominal length) is a contributor to this high rate of hernia recurrence; when short esophagus is diagnosed, Collis-Nissen gastroplasty is frequently used to correct the abnormality.
This article sought to document long-term outcomes of patients treated with this approach. 5-year follow-up data were gathered on a prospectively enrolled cohort of patients (n = 80) with short esophagus who underwent Collis-Nissen gastroplasty. No postoperative leaks or patient deaths occurred during the follow up interval. Hernia recurrence was documented in 8.8% of the cohort at 5-year follow up. Symptoms of reflux improved steadily during the follow-up interval. Dysphagia was present preoperatively in 30 patients, and this improved in 26. New onset dysphagia occurred in six patients. Quality of life scores improved consistently.
The authors concluded that Collis-Nissen gastroplasty was safe and provided long-term improvement of symptoms and quality of life in this patient group.
Gil LA, Deans KJ, Minneci PC. Management of Pilonidal Disease: A Review. JAMA Surg. 2023 doi: 10.1001/jamasurg.2023.0373 [published Online First: 20230531]
This article provided a clear and easily readable review of pilonidal disease. Data cited in the article showed that pilonidal disease occurs in up to 100 individuals per 100,000, and the incidence has steadily increased over the last decade.
The disease is believed to be caused by entrapment of hair shafts and debris under the skin of the gluteal cleft. Hair characteristics combined with increased gluteal cleft depth and narrowness along with friction caused by contact of the two sides of the cleft contribute to risk for development of pilonidal disease. Symptoms range from asymptomatic pits to abscesses and sinus formation.
Management strategies include nonoperative and operative approaches. Nonoperative management can consist of improved cleanliness and shaving of hair, epilation (removal of hair shaft and bulb using laser or intense light pulses), and phenol/fibrin injection. Excisions of the pilonidal cyst/sinus with midline closure or secondary healing are associated with recurrences in up to 42% of patients. Lower recurrence rates (<20%) are documented in published research on use of excision and off-midline flap closure techniques. Illustrations of these techniques (including several variations of off-midline flap closures) are included in the article.
A suggested treatment algorithm was proposed by the authors and illustrated in the article. The authors recommended that treatment approaches be chosen based on disease severity and that additional high-quality studies comparing treatment outcomes should be performed.