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

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.