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

True Short Esophagus in Gastroesophageal Reflux Disease

“…In conclusion, we demonstrate that in the PPI era, TSE is present in almost one-third of cases undergoing routine surgery for GERD or NAHH; it is particularly frequent in type III and IV NAHH, and is currently, but not correctly, called “giant paraesophageal hernia.” 22 Based on a critical interpretation of the literature, it could be argued that hundreds of SASF procedures have produced good clinical results most likely without consciously performing these procedures 12 . This speculation, when combined with the results we achieved in our SASF series, should be sufficient to attract the interest of esophageal surgeons, including believers and nonbelievers within the domain of short esophagus, and justify, from an ethical point of view, their participation in a randomized multicenter trial to compare the results of CN and SASF in cases with TSE using the clinical and surgical methods we adopted in the case series in the present study.…”

“…11,13 Cases of HH recurrence diagnosed by barium swallow, even those smaller than 2 cm, and cases in which continuous or timed medical therapy (H2 blockers and/or PPIs) were administered, were graded as a ''poor outcome'' in the absence of symptoms or esophagitis. 11,13,22 Barium swallow was performed pre and postoperatively to define the relationship between the GEJ and the diaphragmatic hiatus in the upright and supine positions, and also the morphology and type of HH. Cases were distributed into 2 groups: the axial HH (AHH) group and the nonaxial HH (NAHH) group.…”

“…Reflux symptoms (RS), dysphagia (S), dyspepsia (D), and grade of RE were scored according to Visick modified validated semiquantitative scales, 20,21 as was the surgical outcome global evaluation resulting from the combination of postoperative grades for RS, S, D, and RE parameters (Table 2). 11,13 Cases of HH recurrence diagnosed by barium swallow, even those smaller than 2 cm, and cases in which continuous or timed medical therapy (H2 blockers and/or PPIs) were administered, were graded as a “poor outcome” in the absence of symptoms or esophagitis 11,13,22 . Barium swallow was performed pre and postoperatively to define the relationship between the GEJ and the diaphragmatic hiatus in the upright and supine positions, and also the morphology and type of HH.…”