Editorial comment: The short esophagus: Going, going, gone?

doi:10.1067/msy.2003.116

Surgery

Volume 133, Issue 4, April 2003, Pages 364-367

https://doi.org/10.1067/msy.2003.116 Get rights and content

Abstract

Surgery 2003;133:364-7.

References (18)

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An operation for haitus hernia with short esophagus
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Long-term results of classic antireflux surgery in 152 patients with Barrett's esophagus: clinical, radiologic, endoscopic, manometric, and acid reflux test analysis before and late after operation
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JL Collis et al.
Anatomy of the crura of the diaphragm and the surgery of hiatus hernia
Thorax
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JL. Collis
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Thorax
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JL. Collis
The diaphragm and hiatus hernia
Proceedings of the Royal Society of Medicine.
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CW Windsor et al.
Anaemia and hiatus hernia: experience in 450 patients
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A tailored approach to antireflux surgery
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Treatment of advanced gastroesophageal reflux disease with Collis gastroplasty and Belsey partial fundoplication
Archives of Surgery
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There are more references available in the full text version of this article.

Cited by (15)

Paraesophageal Hernia: Clinical Presentation, Evaluation, and Management Controversies
2009, Thoracic Surgery Clinics
Citation Excerpt :
Other risk factors that may predispose a patient to develop esophageal shortening include Barrett esophagus, scleroderma, and Crohn disease.65,68 Identifying patients preoperatively with shortened esophagus is problematic.69,70 There is no test that can be performed that accurately identifies the presence and degree of esophageal shortening.
The short esophagus: Intraoperative assessment of esophageal length
2008, Journal of Thoracic and Cardiovascular Surgery
Citation Excerpt :
These measurements produced three types of data: (1) the distance between the EG junction clip and the diaphragm (in centimeters), as marked with a minus sign when the junction is placed below the diaphragm or a plus sign when the junction is placed above the diaphragm; (2) the length (in centimeters) of the isolated thoracic esophagus, from the top level of the mobilization to the apex of the hiatus; (3) an arbitrary categorization of cases as “long” or “short” when there was more than or less than 1.5 cm subdiaphragmatic esophagus, respectively. In fact, if the antireflux procedure is to be performed without undue tension, it is generally accepted that at least 2.5 cm of tubular esophagus should lie below the hiatus in the absence of tension on the stomach.1,8,9,10,11,21 The mediastinal dissection was extended and the antireflux technique (hiatoplasty and fundoplication) was chosen by the first surgeon, according to personal experience.
To define the frequency and predictors of short esophagus in a case series of patients undergoing antireflux surgery.
An observational prospective study from September 10, 2004, to October 31, 2006, was performed at 8 centers. The distance between the esophagogastric junction as identified by intraoperative esophagoscopy and the apex of the diaphragmatic hiatus was measured intraoperatively before and after esophageal mediastinal dissection; a distance of 1.5 cm was arbitrarily determined to categorize cases as long (>1.5 cm) or short (≤1.5 cm).
One hundred eighty patients were enrolled; the mean age of patients was 49.3 ± 15.3 years. At the first measurement (after isolation of the esophagogastric junction), the median distance between the esophagogastric junction and the apex of the hiatus was equal to or shorter than 1.5 cm in 68 (37.7%) patients; at the second measurement (after full mediastinal isolation), the measurement of the distance was still shorter than 1.5 cm in 34 (18.8%) patients and between 1.5 and 2.5 cm in 24 (13.4%) patients. The median length of the mediastinal esophageal dissection was 6 cm (range 1–12 cm). An esophageal lengthening procedure was performed in 26 (14.4%) patients. The duration of symptoms (P = .047), the General Health domain of the SF-36 questionnaire (P = .001), and an x-ray barium swallow (P = .000) are predictive factors for a “true” short esophagus.
True short esophagus is present in about 20% of patients undergoing routine antireflux surgery. Radiology, severity, and duration of symptoms are predictors of true foreshortening.
Functional problems following esophageal surgery
2005, Surgical Clinics of North America
Citation Excerpt :
A foreshortened esophagus is suspected preoperatively if the endoscopic distance between the gastroesophageal junction and the diaphragmatic impression is greater than 5 cm, or intraoperatively if an intra-abdominal length of 2 to 3 cm of adequately mobilized esophagus cannot be secured. In these patients, a Collis gastroplasty should be considered to create 3 cm of neoesophagus [10–12]; however, the actual existence of short esophagus is questioned by a number of surgeons [13,14]. In addition, extensive mediastinal esophageal dissection may eliminate the need for a gastroplasty [8,15].
Reoperative laparoscopic fundoplication for the treatment of failed fundoplication
2004, Journal of Thoracic and Cardiovascular Surgery
This study was undertaken to determine the safety and efficacy of reoperative laparoscopic fundoplication for patients with failed fundoplication.
Thirty-nine of 612 consecutive patients who had undergone fundoplication underwent laparoscopic reoperative fundoplication for recurrent symptoms, persistent dysphagia, or gas bloat. An additional 15 patients were referred from outside facilities for reoperation. Preoperative evaluation included barium swallow (n = 54), esophagogastroduodenoscopy (n = 54), esophageal manometry (n = 34), and 24-hour ambulatory pH measurement (n = 32). Symptom severity before and after surgery was evaluated with a visual analog scoring scale. The mean follow-up was 22.5 months.
The primary symptoms that led to reoperation in the 54 patients were heartburn (n = 26), dysphagia (n = 23), and gas bloat (n = 5). Average time from initial operation to reoperation was 22.7 months. There were 3 conversions to open technique. An anatomic reason for the failure of the initial fundoplication was found in 69% of cases: slipped or misplaced fundoplication (n = 14), disrupted fundoplication (n = 8), transdiaphragmatic herniation (n = 7), achalasia (n = 1), and tight fundoplication (n = 7). Fourteen patients had 15 perioperative complications. Mean hospital stay was 2.3 days. Symptoms such as heartburn, dysphagia, and gas bloat improved significantly after reoperation; 40% to 50% of patients had scores 0 to 2, 21% to 45% had scores 3 to 7, and 9% to 29% had scores 8 to 10. Proton-pump inhibitor use after operation decreased from 88% to 36%. Fifty-two percent of patients completely discontinued any antireflux medications. Three patients had failure of the reoperation and required additional procedures.
Laparoscopic reoperation for failed fundoplication is feasible and can achieve resolution of symptoms for a significant percentage of patients.
The surgical treatment of the intrathoracic migration of the gastro-oesophageal junction and of short oesophagus in gastro-oesophageal reflux disease
2004, European Journal of Cardio-thoracic Surgery
Short esophagus: Its relationship with fundoplication failure and postoperative recurrence of the hiatal hernia
2021, Benign Esophageal Disease: Modern Surgical Approaches and Techniques

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^*: Reprint requests: Steven R. DeMeester, MD, Assistant Professor of Cardiothoracic Surgery, Norris Comprehensive Cancer Center, 1441 Eastlake Ave, Ste 7418, Los Angeles, CA 90033-0804.

^**: 0039-6060/2003/$30.00 +0

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Original CommunicationsEditorial comment: The short esophagus: Going, going, gone?*,**

Abstract

American Journal of Surgery

J Thorac Surg

Surgery

Anatomy of the crura of the diaphragm and the surgery of hiatus hernia

Thorax

Review of surgical results of hiatus hernia

Thorax

The diaphragm and hiatus hernia

Proceedings of the Royal Society of Medicine.

Anaemia and hiatus hernia: experience in 450 patients

Thorax

A tailored approach to antireflux surgery

J Thorac Cardiovasc Surg

Treatment of advanced gastroesophageal reflux disease with Collis gastroplasty and Belsey partial fundoplication

Archives of Surgery

Original Communications
Editorial comment: The short esophagus: Going, going, gone?*,**