Which of the following statement(s) concerning the surgical options for an anti-reflux operation is/are true?

a.A patient with normal esophageal length and esophageal body motility is best served by laparoscopic Nissen fundoplication

c.A Collis gastroplasty is an additional procedure that can be added in patients with extensive esophageal shortening

d.End-stage reflux disease such as an undilatable stricture or Barrett’s esophagus with high grade dysplagia is best managed by a colon interposition

Patients with normal esophageal length and normal esophageal body motility are best served by a transabdominal Nissen fundoplication. This is now normally done via the laparoscopic route. If the patient is very obese or requires concomitant surgery on the lung or esophageal body, the transthoracic approach is preferable. The presence of a motility disorder alters the operative strategy. If the peristaltic amplitude is low (20 mm Hg) in the distal third of the esophagus, a Nissen fundoplication would create too much resistance and lead to dysphagia. In this situation the Belsey fundoplication is a better choice. Moreover, it allows the surgeon to mobilize the esophagus to a much greater extent than is possible through the abdomen. In addition to extensive mobilization, a Collis gastroplasty can be created to produce an extra 5 cm of “neoesophagus” around which a Belsey procedure can be added. End-stage reflux disease, for example, when there is an undilatable stricture or after previous unsuccessful anti-reflux operations or when Barrett’s esophagus leads to high grade dysplagia, is best served by esophageal replacement. The most durable substitute is the colon, and the functional results are especially good if the vagus nerves are intact.