True Short Esophagus in Gastroesophageal Reflux Disease: Old Controversies With New Perspectives.
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
01 08 2021
01 08 2021
Historique:
pubmed:
7
9
2019
medline:
15
9
2021
entrez:
7
9
2019
Statut:
ppublish
Résumé
To explore the true short esophagus (TSE) frequency and long-term results of patients undergoing gastroesophageal reflux disease (GERD) or hiatus hernia (HH) surgery. The existence and treatment of TSE during GERD/HH surgery is controversial. Satisfactory long-term results have been achieved with and without surgical techniques dedicated to TSE. In 311 consecutive patients undergoing minimally invasive surgery for GERD/HH, the distance between the endoscopically-localized gastroesophageal junction (GEJ) and the apex of the diaphragmatic hiatus after maximal thoracic esophagus mobilization was measured. A standard Nissen fundoplication (SN) was performed in cases with an abdominal length >1.5 cm; in cases of TSE (abdominal length <1.5 cm), a Collis-Nissen (CN) or stomach around the stomach fundoplication (SASF) in elderly patients was performed. The fundoplication superior margin was fixed below the hiatus, but over the GEJ. The patients' symptoms, and radiological and endoscopic data were pre/postoperatively recorded. After intrathoracic esophageal mobilization (median 9 cm), TSE was diagnosed in 31.8% of 311 cases. With a median follow-up of 96 months (309 patients), HH relapse was radiologically diagnosed in 3.2% of patients, with excellent, good, fair, and poor outcomes in 45.6%, 44.3%, 6.2%, and 3.9% of cases, respectively, and no significant differences among SN (68.5%), CN (26.4%), and SASF (5.2%). TSE was present in 31.8% of patients routinely submitted to GERD/HH surgery. In the presence of TSE, CN and SASF performed according to determined surgical principles may achieve similar satisfactory results. This finding warrants confirmation with a prospective multicenter study.
Sections du résumé
OBJECTIVE
To explore the true short esophagus (TSE) frequency and long-term results of patients undergoing gastroesophageal reflux disease (GERD) or hiatus hernia (HH) surgery.
BACKGROUND
The existence and treatment of TSE during GERD/HH surgery is controversial. Satisfactory long-term results have been achieved with and without surgical techniques dedicated to TSE.
METHODS
In 311 consecutive patients undergoing minimally invasive surgery for GERD/HH, the distance between the endoscopically-localized gastroesophageal junction (GEJ) and the apex of the diaphragmatic hiatus after maximal thoracic esophagus mobilization was measured. A standard Nissen fundoplication (SN) was performed in cases with an abdominal length >1.5 cm; in cases of TSE (abdominal length <1.5 cm), a Collis-Nissen (CN) or stomach around the stomach fundoplication (SASF) in elderly patients was performed. The fundoplication superior margin was fixed below the hiatus, but over the GEJ. The patients' symptoms, and radiological and endoscopic data were pre/postoperatively recorded.
RESULTS
After intrathoracic esophageal mobilization (median 9 cm), TSE was diagnosed in 31.8% of 311 cases. With a median follow-up of 96 months (309 patients), HH relapse was radiologically diagnosed in 3.2% of patients, with excellent, good, fair, and poor outcomes in 45.6%, 44.3%, 6.2%, and 3.9% of cases, respectively, and no significant differences among SN (68.5%), CN (26.4%), and SASF (5.2%).
CONCLUSIONS
TSE was present in 31.8% of patients routinely submitted to GERD/HH surgery. In the presence of TSE, CN and SASF performed according to determined surgical principles may achieve similar satisfactory results. This finding warrants confirmation with a prospective multicenter study.
Identifiants
pubmed: 31490280
pii: 00000658-202108000-00023
doi: 10.1097/SLA.0000000000003582
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
331-338Informations de copyright
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors have no conflicts of interest to disclose.
Références
Nissen R. Gastropexy and “fundoplication” in surgical treatment of hiatal hernia. Am J Digest Dis 1961; 6:954.
Maillet P, Cuche J, Revelin P, et al. Les resultants eloignes du traitement chirurgical des hernies hiatal es de l’adulte (376 observations). Lyon Chir 1973; 69:203–207.
Lortat-Jacob JL. L’endo-brachyesophage. Ann Chir 1957; 11:1247.
Skinner DB, Belsey RHR. Surgical management of esophageal reflux and hiatus hernia: long-term results with 1030 patients. J Thorac Cardiovasc Surg 1967; 53:33–57.
Belsey R. Surgical treatment of hiatus hernia and reflux esophagitis: introduction. World J Surg 1977; 1:421–423.
Pearson FG, Cooper JD, Patterson GA, et al. Gastroplasty and fundoplication for complex reflux problems. Long-term results. Ann Surg 1987; 206:473–481.
Collis JL. An operation for hiatus hernia with short esophagus. J Thorac Surg 1957; 34:768–778.
Hill L, Gelfand M, Bauermeister D. Semplified management of reflux esophagitis with stricture. Ann Surg 1970; 172:638–651.
Csendes A, Braghetto I, Burdiles P, et al. Long-term results of classic antireflux surgery in 152 patients with Barrett's esophagus: clinical, radiologic, endoscopic, manometric, and acid reflux test analysis before and late after operation. Surgery 1998; 123:645–657.
El-Serag HB, Sonnenberg A. Outcome of erosive reflux esophagitis after Nissen fundoplication. Am J Gastroenterol 1999; 94:1771–1776.
Mattioli S, Lugaresi M, Costantini M, et al. The short esophagus: intraoperative assessment of esophageal length. J Thorac Cardiovasc Surg 2008; 136:834–841.
Banki F, Kaushik C, Roife D, et al. Laparoscopic repair of large hiatal hernia without the need for esophageal lengthening with low morbidity and rare symptomatic recurrence. Semin Thorac Cardiovasc Surg 2017; 29:418–425.
Mattioli S, Lugaresi ML, Di Simone MP, et al. The surgical treatment of the intrathoracic migration of the gastrooesophageal junction and of short esophagus in gastro-oesophageal reflux disease. Eur J Cardiothorac Surg 2004; 25:1079–1088.
Landreneau RJ, Del Pino M, Santos R. Management of paraesophageal hernias. Surg Clin North Am 2005; 85:411–432.
Lugaresi M, Mattioli B, Daddi N, et al. Surgery for type III-IV hiatal hernia: anatomical recurrence and global results after elective treatment of short oesophagus with open and minimally invasive surgery. Eur J Cardiothorac Surg 2016; 49:1137–1143.
Lugaresi M, Mattioli B, Perrone O, et al. Results of left thoracoscopic Collis gastroplasty with laparoscopic Nissen fundoplication for the surgical treatment of true short oesophagus in gastro-oesophageal reflux disease and Type III–IV hiatal hernia. Eur J Cardiothorac Surg 2016; 49:e22–e30.
Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol 2013; 108:308–328.
Low DE. The short esophagus-recognition and management. J Gastrointest Surg 2001; 5:458–461.
Lundell LR, Dent J, Bennett JR, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut 1999; 45:172–180.
Visick C. In Williams A, Cox AG, editors. Vagotomy on Trial. Pitman Press: Bath; 1973.
DeMeester TR, Johnson LF, Kent AH. Evaluation of current operations for the prevention of gastroesophageal reflux. Ann Surg 1974; 180:511–525.
Mattioli S. Why consider a paraesophageal hernia giant and a long esophagus short? Definitions and results of surgery for paraesophageal hiatal hernias. J Thorac Cardiovasc Surg 2018; 155:1345.
Gastal OL, Hagen JA, Peters JH, et al. Short esophagus: analysis of predictors and clinical implications. Arch Surg 1999; 134:633–638.
Kohn GP, Price RR, DeMeester SR, et al. Guidelines for the management of hiatal hernia. Surg Endosc 2013; 27:4409–4428.
DeMeester SR, DeMeester TR. The short esophagus: going, going, gone? Surgery 2003; 133:364–367.
Horvath KD, Swanstrom LL, Jobe BA. The short esophagus: pathophysiology, incidence, presentation, and treatment in the era of laparoscopic antireflux surgery. Ann Surg 2000; 232:630–640.
Luketich JD, Grondin SC, Pearson FG. Minimally invasive approaches to acquired shortening of the esophagus: laparoscopic Collis–Nissen gastroplasty. Semin Thorac Cardiovasc Surg 2000; 12:173–178.
Awad ZT, Mittal SK, Roth TA, et al. Esophageal shortening during the era of laparoscopic surgery. World J Surg 2001; 25:558–561.
Urbach DR, Khajanchee YS, Glasgow RE, et al. Preoperative determinants of an esophageal lengthening procedure in laparoscopic antireflux surgery. Surg Endosc 2001; 15:1408–1412.
Nason KS, Luketich JD, Witteman BP, et al. The laparoscopic approach to paraesophageal hernia repair. J Gastrointest Surg 2012; 16:417–426.
Kunio NR, Dolan JP, Hunter JG. Short esophagus. Surg Clin North Am 2015; 95:641–652.
Lugaresi M, Mattioli S, Aramini B, et al. The frequency of true short oesophagus in type II-IV hiatal hernia. Eur J Cardiothorac Surg 2013; 43:30–36.
Mattioli S, D’Ovidio F, Di Simone MP, et al. Clinical and surgical relevance of the progressive phases of intrathoracic migration of the gastroesophageal junction in gastroesophageal reflux disease. J Thorac Cardiovasc Surg 1998; 116:267–275.
Pearson FG. Expert commentary: a multicenter study to define the incidence of short esophagus in surgical patients with gastroesophageal reflux disease. J Thorac Cardiovasc Surg 2008; 136:842.
Awad ZT, Filipi CJ, Mittal SK, et al. Left side thoracoscopically assisted gastroplasty: a new technique for managing the shortened esophagus. Surg Endosc 2000; 14:508–512.
Gozzetti G, Pilotti V, Spangaro M, et al. Pathophysiology and natural history of acquired short esophagus. Surgery 1987; 102:507–514.
Rice TW. Why antireflux surgery fails. Dig Dis 2000; 18:43–47.
Targarona EM, Grisales S, Uyanik O, et al. Long-term outcome and quality of life after laparoscopic treatment of large paraesophageal hernia. World J Surg 2013; 37:1878–1882.
Madan AK, Frantzides CT, Patsavas KL. The myth of the short esophagus. Surg Endosc 2004; 18:31–34.
Jobe BA, Horvath KD, Swanstrom LL. Postoperative function following laparoscopic Collis gastroplasty for shortened esophagus. Arch Surg 1998; 133:867–874.