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

Marcin Migaczewski; Anna Zub-Pokrowiecka; Agata Grzesiak-Kuik; Michał Pędziwiatr; Piotr Major; Mateusz Rubinkiewicz; Marek Winiarski; Michał Natkaniec; Andrzej Budzyński

doi:10.5114/wiitm.2015.48571

eISSN: 2299-0054
ISSN: 1895-4588

Videosurgery and Other Miniinvasive Techniques

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1/2015
vol. 10

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abstract:

Original paper

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

Marcin Migaczewski

,

Anna Zub-Pokrowiecka

,

Agata Grzesiak-Kuik

,

Michał Pędziwiatr

,

Piotr Major

,

Mateusz Rubinkiewicz

,

Marek Winiarski

,

Michał Natkaniec

,

Andrzej Budzyński

Videosurgery Miniinv 2015; 10 (1): 10–14

DOI: https://doi.org/10.5114/wiitm.2015.48571

Online publish date: 2015/01/27

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Introduction: The 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.

Aim: To analyze the prevalence of short esophagus in patients subjected to laparoscopic Nissen fundoplication.

Material and methods: The study included 202 patients who were subjected to laparoscopic Nissen fundoplication.

Results: As 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.

Conclusions: The 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.

keywords:

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

Marcin Migaczewski , Anna Zub-Pokrowiecka , Agata Grzesiak-Kuik , Michał Pędziwiatr , Piotr Major , Mateusz Rubinkiewicz , Marek Winiarski , Michał Natkaniec , Andrzej Budzyński

laparoscopy, Nissen fundoplication, antireflux surgery, short esophagus

Marcin Migaczewski

,

Anna Zub-Pokrowiecka

,

Agata Grzesiak-Kuik

,

Michał Pędziwiatr

,

Piotr Major

,

Mateusz Rubinkiewicz

,

Marek Winiarski

,

Michał Natkaniec

,

Andrzej Budzyński