BACKGROUND: The shortened esophagus has long been recognized as a potential complicating factor for reflux surgery or the repair of paraesophageal hernias. We discuss the incidence of shortened esophagus encountered in a prospective series of laparoscopic hiatal hernia repairs and present our current operative strategies for dealing with this problem, including a new technique for preforming a cut Collis gastroplasty for severe cases. METHODS: A prospectively gathered database on laparoscopic fundoplications (n = 213) and giant paraesophageal hernia repairs (n = 25) revealed 34 (14%) patients who had shortened esophagus as defined by the gastroesophageal (GE) junction being > 5 cm above the hiatus. Presentation preoperative diagnosis, operative times, techniques, and outcomes were evaluated. RESULTS: Three categories of dissection were determined from review of the operative data of these 34 patients. Category I (a normal esophagus easily brought into the abdominal cavity with minimal dissection) occurred in 30% of patients. Category II occurred in 50% of patients and was defined as shortened esophagus requiring extensive mediastinal dissection to allow the GE junction to be brought 2 cm below the diaphragm. Category III patients (20%) were unable, in spite of extensive dissection, to have their GE junction sufficiently reduced to permit fundoplication. Four of these patients had a simple cural closure and gastropexy. Three patients underwent an endoscopic Collis gastroplasty to lengthen the esophagus and allow a tension-free fundoplication. Patients who had a type I or type III dissection with Collis gastroplasty did uniformly well. Patients having type II dissections or no fundoplication had a higher rate of postoperative hernia recurrences and reflux disease. CONCLUSION: Approximately 14% of patients presenting for surgical treatment of gastroesophageal reflux disease or paraesophageal hernias demonstrate a shortened esophagus. While 30% of these patients are easily treated laparoscopically, 20% to 70% may benefit from an esophageal lengthening procedure. Proper utilization of the Collis gastroplasty should minimize the incidence of postoperative dysphagia, postoperative acid reflux, and hiatal hernia recurrence.
BACKGROUND: The shortened esophagus has long been recognized as a potential complicating factor for reflux surgery or the repair of paraesophageal hernias. We discuss the incidence of shortened esophagus encountered in a prospective series of laparoscopic hiatal hernia repairs and present our current operative strategies for dealing with this problem, including a new technique for preforming a cut Collis gastroplasty for severe cases. METHODS: A prospectively gathered database on laparoscopic fundoplications (n = 213) and giant paraesophageal hernia repairs (n = 25) revealed 34 (14%) patients who had shortened esophagus as defined by the gastroesophageal (GE) junction being > 5 cm above the hiatus. Presentation preoperative diagnosis, operative times, techniques, and outcomes were evaluated. RESULTS: Three categories of dissection were determined from review of the operative data of these 34 patients. Category I (a normal esophagus easily brought into the abdominal cavity with minimal dissection) occurred in 30% of patients. Category II occurred in 50% of patients and was defined as shortened esophagus requiring extensive mediastinal dissection to allow the GE junction to be brought 2 cm below the diaphragm. Category III patients (20%) were unable, in spite of extensive dissection, to have their GE junction sufficiently reduced to permit fundoplication. Four of these patients had a simple cural closure and gastropexy. Three patients underwent an endoscopic Collis gastroplasty to lengthen the esophagus and allow a tension-free fundoplication. Patients who had a type I or type III dissection with Collis gastroplasty did uniformly well. Patients having type II dissections or no fundoplication had a higher rate of postoperative hernia recurrences and reflux disease. CONCLUSION: Approximately 14% of patients presenting for surgical treatment of gastroesophageal reflux disease or paraesophageal hernias demonstrate a shortened esophagus. While 30% of these patients are easily treated laparoscopically, 20% to 70% may benefit from an esophageal lengthening procedure. Proper utilization of the Collis gastroplasty should minimize the incidence of postoperative dysphagia, postoperative acid reflux, and hiatal hernia recurrence.
Authors: Richard Lu; Alex Addo; Andrew Broda; Zachary Sanford; Adam Weltz; H Reza Zahiri; Adrian Park Journal: J Gastrointest Surg Date: 2019-11-25 Impact factor: 3.452
Authors: Luis Durand; Roberto De Antón; Miguel Caracoche; Enrique Covián; Mariano Gimenez; Pedro Ferraina; Lee Swanström Journal: Surg Endosc Date: 2011-10-15 Impact factor: 4.584
Authors: Fernando Augusto Mardiros Herbella; Jose Carlos Del Grande; Ramiro Colleoni Journal: J Gastrointest Surg Date: 2003 Sep-Oct Impact factor: 3.452