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Clinical Advances, Opportunities, and Challenges in Digestive Diseases of the Foregut

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Special Issue Editors

Dr. Valentin Mocanu

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Guest Editor

Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
Interests: obesity; therapeutic endoscopy; gut microbiome; dietary fiber; probiotics; inflammatory bowel disease

Dr. Salvador Navarrete

E-Mail Website
Guest Editor

Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
Interests: obesity; foregut; gut malrotation

Special Issue Information

Dear Colleagues,

The progress in dietary, endoscopic, and surgical interventions addressing the ever-growing burden of both benign and malignant foregut diseases over the last decade has been unparalleled. From gut microbe-derived biotherapeutics aimed at modulating obesity and metabolic disease—arguably the most important diseases of our generation—to novel endoscopic approaches treating much rarer conditions such as gastroparesis and achalasia, these innovations have expanded our fundamental understanding and treatment options in the field of foregut diseases. For this Special Issue, we welcome the submission of papers on clinical advances, opportunities, and challenges in digestive diseases of benign foregut diseases, including, but not limited to, obesity, gastroparesis, achalasia, and reflux. We welcome your submissions and look forward to working with you to advance the field of foregut diseases through innovation and collaboration.

Dr. Valentin Mocanu
Dr. Salvador Navarrete
Guest Editors

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17 pages, 2531 KB

Open AccessSystematic Review

Does the Addition of a Collis Gastroplasty to Antireflux Surgery Reduce Hiatal Hernia Recurrence?: A Systematic Review and Meta-Analysis

by Faith Trinh, Sukhdeep Jatana, Haley Frerichs, Zaharadeen Jimoh, Steffane McLennan, Armin Rouhi, Janice Y. Kung, Vickie Ringuette, Uzair Jogiat, Simon Turner, Daniel Birch, Noah J. Switzer and Shahzeer Karmali

J. Clin. Med. 2026, 15(10), 3827; https://doi.org/10.3390/jcm15103827 - 15 May 2026

Viewed by 206

Abstract

Introduction: The role of Collis gastroplasty has traditionally been reserved for patients with a shortened esophagus due to chronic gastroesophageal reflux disease (GERD). However, its necessity has been questioned, leading to a decline in popularity. This systematic review and meta-analysis aimed to evaluate the efficacy of hiatal hernia repair with fundoplication, with versus without Collis gastroplasty. Methods: A systematic search of Ovid MEDLINE, Ovid Embase, Scopus, Web of Science Core Collection, and the Cochrane Library (via Wiley) was performed in May 2025. Studies were included if they compared outcomes or the safety profile of Collis gastroplasty versus no Collis gastroplasty during fundoplication for hiatal hernia repair. Meta-analyses were conducted using a random-effects model and restricted maximum likelihood. Results: Of 664 unique results, 17 studies comprising 4048 patients were included. There was a female predominance (65.4%), with a weighted mean age of 58.9 ± 14.0 years and follow-up of 43.5 ± 43.1 months. Patients who underwent Collis gastroplasty represented 35.8% of the cohort. Nissen fundoplication was the most common procedure in both the Collis (91.9%) and non-Collis (84.5%) groups. Most studies had selection bias, in which only patients who did not have sufficient intraoperative intra-abdominal esophageal length underwent Collis gastroplasty. Recurrence rates were similar (13.5% vs. 13.2%). Collis gastroplasty was not associated with a reduction in hiatal hernia recurrence (OR 0.53, 95% CI 0.23–1.22). Symptom outcomes, including regurgitation (OR 0.53, 95% CI 0.05–5.39), reflux (OR 0.81, 95% CI 0.03–22.12), dysphagia (OR 1.12, 95% CI 0.62–2.04), and use of antireflux medication on follow-up (OR 1.15, 95% CI 0.62–2.15), were not significantly different. However, Collis gastroplasty was associated with a higher risk of complications, including overall complications (OR 2.63, 95% CI 1.55–4.46), leak (OR 3.35, 95% CI 1.11–10.05), and surgical site infection (OR 8.28, 95% CI 1.16–59.10). There were no significant differences in abscess formation (OR 5.97, 95% CI 0.77–46.49), length of stay (mean difference 0.36 days, 95% CI −0.30 to 1.01), readmission (OR 1.13, 95% CI 0.36–3.60), reoperation (OR 1.24, 95% CI 0.64–2.41), or mortality (OR 1.08, 95% CI 0.45–2.57). Conclusions: Collis gastroplasty was not associated with a decreased risk of hiatal hernia recurrence or improvement in other efficacy measures, but this is in the context of a strong component of selection bias. In this context, there may be a role for Collis gastroplasty in difficult cases if the rate of recurrence does not differ from those with sufficient length, but this must be balanced against a significantly increased risk of complications. Full article

(This article belongs to the Special Issue Clinical Advances, Opportunities, and Challenges in Digestive Diseases of the Foregut)

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