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

• Published in: European journal of cardio-thoracic surgery 2013-02, Vol.43 (2), p.e30-e36
• Main Authors: Lugaresi, Marialuisa, Mattioli, Sandro, Aramini, Beatrice, D'Ovidio, Frank, Di Simone, Massimo Pierluigi, Perrone, Ottorino
• Format: Article
• Language: English
• Subjects: Aged; Barium Sulfate; Contrast Media; Diaphragm - pathology; Esophagogastric Junction - pathology; Esophagogastric Junction - surgery; Esophagoscopy - methods; Esophagus - abnormalities; Esophagus - diagnostic imaging; Female; Gastroesophageal Reflux - diagnostic imaging; Gastroesophageal Reflux - pathology; Gastroesophageal Reflux - surgery; Gastroscopy - methods; Hernia, Hiatal - diagnostic imaging; Hernia, Hiatal - pathology; Hernia, Hiatal - surgery; Humans; Intraoperative Care; Laparoscopy - methods; Male; Middle Aged; Radiography; Recurrence; Treatment Outcome
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezs602

OBJECTIVES The misdiagnosis of short oesophagus may occur on recurrence of the hernia after surgery for type II-IV hiatal hernia (HH). The frequency of short oesophagus in type II-IV hernia is undefined. The aim of this study was to assess the frequency of true short oesophagus in patients undergoing surgery for type II-IV hernia. METHODS Thirty-four patients with type II-IV hernia underwent minimally invasive surgery. After full isolation of the oesophago-gastric junction, the position of the gastric folds was localized endoscopically and two clips were applied in correspondence. The distance between the clips and the diaphragm (intra-abdominal oesophageal length) was measured. When the intra-abdominal oesophagus was 1.5 cm in 17 patients (4 type II, 11 type III and 2 type IV) and ≤1.5 cm in 17 patients (13 type III and 4 type IV hernia). No statistically significant differences were found between patients with intra-abdominal oesophageal length > or ≤1.5 cm with respect to symptoms duration and severity. Global results (median follow-up 48 months) were excellent in 44% of patients, good in 50%, fair in 3% and poor in 3%. HH relapse occurred in 3%. CONCLUSIONS 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. ClinicalTrials.gov ID NCT01587859. https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0003J7U&selectaction=View&uid=U0000GED&ts=4&cx=uweuc0.