The short esophagus: Intraoperative assessment of esophageal length

Abstract

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.

Giant Hiatus Hernia and Association with Gastro-Oesophageal Reflux: A Review

“…75 patients were assessed using 24-hr oesophageal pH testing in 3 groups of patients with HH < 3 cm, 3-5 cm and > 5 cm. They found the group with larger HH had agus has been reported to be 7% to 19% in patients with reflux disease and a large HH [19,45].…”

“…In most cases adequate mobilisation of the mediastinal oesophagus is sufficient to restore a segment into the abdomen. For those proposing an oesophageal lengthening procedure, there are no objective means to determine the optimal intra-abdominal oesophageal length [45]. For patients having surgical intervention, where the focus has been the achievement and maintenance of a segment of intra-abdominal oesophagus.…”

“…In the modern era, the importance of the short oesophagus is debated. It has been suggested that due to the liberal use of proton pump inhibitors, the incidence of true fibrous shortening is rare and only occurs in the setting of severe oesophageal stricturing and/or a large fixed HH [38,40,41,45]. The incidence of a shortened oesoph-ically fit, should be offered operative repair.…”

Gastroplastia a Collis associada à fundoplicatura parcial ou total: estudo experimental

“…Mercer and Hill 19 believed that it has always been possible to obtain abdominal esophagus segment to an adequate surgical repair, while others have recognized this situation and emphasized the negative influence on surgical results 10,30 . At intra-operative assessment on eight different study centers, it had been about 20% the incidence of acquired short esophagus 18 . The ideal surgical treatment aims to restore a normal gastric transit and ABCD Arq Bras Cir Dig 2011;24(1): 3-8 prevent subsequent reflux 30 .…”

“…The technique described by Collis associated with fundoplication for the patients treatment with esophagitis and strictures that lead to the esophagus shortening reached the main proposed objectives today: there is the esophagus preservation, the lower sphincter is excised, the vagus nerves remain intact 24 , it is obtained a sub-diaphragmatic neoesophagus segment for an adequate repair 2,11 , a tension elimination on the repair 2,23 , it is used for inflamed tissue, and not fundoplication 2,21,22 , and JEG angulation remains 18 . This is associated with low morbidity, mortality and anatomic hernia and reflux recurrence 27 .…”