The frequency of true short oesophagus in type II–IV hiatal hernia

Lugaresi, Marialuisa; Mattioli, Sandro; Aramini, Beatrice; D’Ovidio, Frank; Simone, Massimo Pierluigi Di; Perrone, Ottorino

doi:10.1093/ejcts/ezs602

Cited by 12 publications

(13 citation statements)

References 24 publications

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“…Since the first hiatal hernia classification, 2 paraesophageal hiatal hernia has been characterized by the placement of the esophagogastric junction in the abdomen without esophageal shortening. As a direct consequence, the esophagus has a normal length, 3 and only the gastric fundus is displaced into the chest. I thus find it difficult to define any paraesophageal hiatal hernia as giant.…”

Section: Why Consider a Paraesophageal Hernia Giant And A Long Esophagus Short? Definitions And Results Of Surgery For Paraesophageal Hiamentioning

confidence: 99%

Why consider a paraesophageal hernia giant and a long esophagus short? Definitions and results of surgery for paraesophageal hiatal hernias

Mattioli

2018

The Journal of Thoracic and Cardiovascular Surgery

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Section: Why Consider a Paraesophageal Hernia Giant And A Long Esophagus Short? Definitions And Results Of Surgery For Paraesophageal Hiamentioning

confidence: 99%

Why consider a paraesophageal hernia giant and a long esophagus short? Definitions and results of surgery for paraesophageal hiatal hernias

Mattioli

2018

The Journal of Thoracic and Cardiovascular Surgery

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“…Lugaresi et al demonstrated that up to 60% of type II-IV hiatal hernias were measured as short postoperatively. 8 Therefore, some recommend a Collis wedge Simultaneous thoraco-laparoscopic hiatal hernia repair 5 gastroplasty to increase intra-abdominal esophageal length. 9 One of the advantages of the simultaneous thoraco-laparoscopic procedure is the ability to mobilize the entire esophagus, ensuring a tension-free position of the esophagus, while cruraplasty can be performed when needed.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous thoraco-laparoscopic repair of giant hiatal hernias: an alternative approach

Derksen

Oor

Yilmaz

et al. 2016

Diseases of the Esophagus

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Laparoscopic repair of giant hiatal hernias with intrathoracic displacement of organs is recommended to relieve troublesome symptoms in patients. During this procedure, incomplete excision of the hernia sac from the mediastinum and omission of creating a 'non-tension-free position' of the cardio-esophageal junction into the abdominal cavity are associated with hiatal hernia recurrence. Giant hiatal hernias therefore often require a thoracotomy or thoracoscopy, to free dense adhesions higher up the chest. These procedures may increase the risk of perioperative morbidity due to lengthy operating times. We developed an operation procedure for giant hiatal hernia repair containing all the benefits of minimal invasive surgery, with overview of both thoracic and abdominal herniated structures. Three patients with a giant hiatal hernia were treated by a simultaneous thoraco-laparoscopic approach, which proved to be technically feasible and safe. Simultaneous thoraco-laparoscopic hernia repair can be considered a reasonable treatment option in selected cases such as type IV hernias, hernia recurrence or traumatic diaphragmatic herniation.

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“…Such cases are referred to as the so-called true short esophagus. However, published data on the prevalence of this condition are inconclusive: while according to some authors this pathology is present in up to 60% of patients qualified for anti-reflux surgery, others have questioned the existence of true short esophagus [ 6 , 7 ]. Although some researchers defined criteria pointing to the presence of short esophagus already at a preoperative stage, according to most authors, the definitive diagnosis can be established no earlier than intraoperatively [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…According to various authors, short esophagus is present in up to 60% of patients qualified for anti-reflux surgery [ 6 ]. However, some other researchers question the presence of this condition [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Incidence of true short esophagus among patients submitted to laparoscopic Nissen fundoplication.

Migaczewski¹,

Zub-Pokrowiecka²,

Grzesiak-Kuik³

et al. 2015

Videosurgery and Other Miniinvasive Techniques

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IntroductionThe last two decades have observed development of surgical treatment of benign conditions of the gastroesophageal junction (GEJ), including anti-reflux surgery, due to the growing popularity of the laparoscopic approach. Migration of the fundoplication band and recurrent hiatal hernia are a result of the lack of correct diagnosis and appropriate management of the so-called short esophagus. According to various authors, short esophagus is present in up to 60% of patients qualified for anti-reflux surgery. However, some researchers question the existence of this condition.AimTo analyze the prevalence of short esophagus in patients subjected to laparoscopic Nissen fundoplication.Material and methodsThe study included 202 patients who were subjected to laparoscopic Nissen fundoplication.ResultsAs many as 96% of the patients qualified for the surgical treatment showed supradiaphragmatic location of the high pressure zone. The extent of GEJ protrusion ranged from 0 cm to 3 cm (mean: 2 cm). The extent of dissection within the mediastinum was determined by the level of GEJ protrusion, and ranged from 5 cm to 12 cm (mean: 6 cm). Upon complete mobilization of the esophagus within the mediastinum, no cases of significantly shortened esophagus, precluding downward retraction of at least a 2.5-cm segment below the diaphragmatic crura, were documented. Therefore, none of the patients required Collis gastroplasty.ConclusionsThe presence of “true” short esophagus is a sporadic finding among patients qualified for anti-reflux surgery. Mediastinal dissection of the esophagus and its mobilization at an appropriate, individually defined level seems a sufficient treatment in the vast majority of these patients.

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The frequency of true short oesophagus in type II–IV hiatal hernia

Abstract: True short oesophagus is present in 57% of type III-IV and in none of type II HHs. The intraoperative measurement of the submerged intra-abdominal oesophagus is an objective method for recognizing these patients.

Cited by 12 publications

References 24 publications

Why consider a paraesophageal hernia giant and a long esophagus short? Definitions and results of surgery for paraesophageal hiatal hernias

Why consider a paraesophageal hernia giant and a long esophagus short? Definitions and results of surgery for paraesophageal hiatal hernias

Simultaneous thoraco-laparoscopic repair of giant hiatal hernias: an alternative approach

Incidence of true short esophagus among patients submitted to laparoscopic Nissen fundoplication.

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