This video demonstrates a laparoscopic Collis-Nissen in a patient with a large hiatal hernia and shortened esophagus. The surgeon demonstrates the resection of the hernia sac and extensive mobilization of the esophagus through the hiatus to achieve adequate length of intra-abdominal esophagus. Despite this, the esophagus was too short and the surgeon performs a Collis gastroplasty using the wedge gastrectomy technique over a 52 French bougie. A 2.5 cm of tension-free intra-abdominal esophagus is achieved. The hiatus is repaired with interrupted non-absorbable sutures inserted posteriorly as well as an additional suture inserted anterior to the esophagus. The posterior repair is reinforced with use of a porcine biological mesh. A standard Nissen fundoplication is performed.

complex cases