Surgical Treatment of Hiatal Hernias by Fundoplication and Gastropexy (Nissen Repair)

The Short Esophagus: Pathophysiology, Incidence, Presentation, and Treatment in the Era of Laparoscopic Antireflux Surgery

“…[1][2][3][4][5][6][7] The result of this interest has been the generation of a wealth of data regarding its pathophysiology and treatment. There is, however, a striking paucity of reference to the short esophagus in the current laparoscopic literature.…”

Laparoscopic treatment of large paraesophageal hernias

“…Even when esophageal calibration is performed during crural repair, one stitch too many may result in dysphagia; at the same time, a recurrence may result if even a single stitch is omitted. To address this problem, a standard gastrostomy or gastropexy has been recommended by many authors as a means of minimizing the risk of recurrence in both open [3,12,13,16,20] and laparoscopic repairs [5,15,26]. Since a nonfixed stomach will, by virtue of the result of a positive intraabdominal pressure and a negative inspiration pressure, herniate into the mediastinum, the use of a gastropexy seems to be the wisest course.…”

“…The need for a concomitant antireflux procedure remains controversial [12,16,19,20,26,29,32,33]. In general, it will depend on the presence of GERD.…”

“…In the last 30 years, the surgical technique has been modified to obtain an adequate reduction and fixation of the stomach into the abdomen in order to avoid three serious postoperative problems: recurrence of the hernia, appearance of dysphagia, and gastroesophageal reflux [1,2,3,4,12,16,17,20]. In conventional surgery, reduction of the stomach and, if necessary, of the esophagus into the abdomen followed by careful approximation of the left and right bundles of the right crus of the diaphragm and some kind of gastropexy has generally been considered the standard treatment [1,2,3,4,9,12,16,17,18,20,22,31]. An antireflux procedure should be performed if symptoms of reflux esophagitis are manifest before operating [12,17,18,19].…”

When did the esophagus start shrinking? The history of the short esophagus

“…9) and Leven 45 proposed a partial gastrectomy in patients with SE to reduce acid production and reflux and prevent esophageal stenosis. Intrathoracic fundoplication: After the popularization of the fundoplication to treat gastroesophageal reflux, some authors performed an intrathoracic fundoplication when the mobilization of the esophagus below the diaphragm was not possible. It was tried for the first time by Krupp and Rossetti in 1966 46 …”