Robot-Assisted Giant Paraesophageal Hernia Repair with Collis Gastroplasty

In this video, the authors demonstrate a robot-assisted Nissen fundoplication with Collis wedge gastroplasty. Following mediastinal dissection and full reduction of the hiatal or giant paraesophageal hernia, the gastric fat pad is mobilized for accurate identification of the gastroesophageal junction. If 2-3 centimeters of tension-free subdiaphragmatic esophageal length cannot be obtained, a Collis wedge gastroplasty may be indicated to decrease risk of recurrence or re-herniation. As shown, a 54 French bougie is placed into the stomach along the lesser curve. The gastric fundus is retracted anteriorly and to the right over the bougie. The first staple line is advanced parallel to the fundus and perpendicular to the bougie. The staple line is continued proximally and parallel to the bougie to complete the wedge. Once the Collis wedge gastroplasty has been completed, routine gastrofundoplication is performed over the tubularized neo-esophagus, allowing for a tension-free wrap.