The preoperative predictability of the short esophagus in patients with stricture or paraesophageal hernia

Mittal, Sumeet K.; Awad, Ziad T.; Tasset, Mark; Filipi, Charles J.; Dickason, Timothy J.; Shinno, Yuki; Marsh, Robert E.; Tomonaga, Tetsuya; Lerner, C A

doi:10.1007/s004640020023

Cited by 67 publications

(30 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We have performed 4 in 44 repairs (9%) which is somewhat higher than other series. We believe, as others [33], that better recognition of who needs a Collis gastroplasty may lead to fewer recurrences. Nevertheless, in truth these controversies cannot be settled by the data presented in this study.…”

Section: Discussionmentioning

confidence: 99%

Surgical Management of Paraesophageal Hernias: Outcome and Quality of Life Analysis / with Invited Commentary

Velanovich

Karmy‐Jones²

2001

Dig Surg

View full text Add to dashboard Cite

Background: Paraesophageal hernias (PEHs) have protean clinical manifestations, and a variety of surgical approaches may be appropriate. We report both surgical and quality-of-life (QoL) outcomes for PEH repairs. Methods: All patients undergoing elective repair of PEHs were evaluated preoperatively for symptoms and the radiologic appearance of the PEH. In addition, patients undergoing elective repair completed the SF-36, a generic QoL instrument, preoperatively and postoperatively. Short-term postoperative complications were recorded. Symptomatic outcomes and QoL outcomes were assessed. Results: Over a 50-month period, 44 PEH repairs were completed. 3 patients represented emergently – 2 with gastric ischemia, 1 with frank gastric necrosis. The most common presenting symptoms were heartburn (48%), chest pain (27%), abdominal pain (20%), regurgitation (20%), dysphagia (18%), and microcytic anemia (18%). Only 4 patients (9%) were truly asymptomatic. 31 repairs were attempted laparoscopically, 5 were converted to open procedures. There were no gastric or esophageal perforations. 91% of patients had resolution of preoperative symptoms. The only death was in a patient with gastric necrosis. 5 of 8 patients treated by crural repair without fundoplication developed postoperative heartburn. Patients treated laparoscopically had superior QoL scores than patients treated by open surgery in the domains of physical functioning (90 vs. 65), role-physical (100 vs. 0), role-emotional (100 vs. 66.7), vitality (80 vs. 55), and social functioning (100 vs. 75). However, there were 3 symptomatic recurrences in the laparoscopic group (11.5%), all in patients with large, type-III hiatal hernias. Conclusions: PEH is a potentially life-threatening disease. Although most can be repaired laparoscopically, specific principles must be individualized to each patient to minimize complications and recurrences. A fundoplication should be added to all repairs. Laparoscopic repairs can produce superior QoL results: however, patients with large, type-III hernias may not be appropriate candidates for laparoscopic repair.

show abstract

Section: Discussionmentioning

confidence: 99%

Surgical Management of Paraesophageal Hernias: Outcome and Quality of Life Analysis / with Invited Commentary

Velanovich

Karmy‐Jones²

2001

Dig Surg

View full text Add to dashboard Cite

show abstract

“…Some authors have attempted to detect short esophagus preoperatively [2,15,29,40]. Awad et al [2] examined the following criteria for their predictive value for short esophagus: (1) endoscopic evidence of stricture or Barrett's esophagus; (2) an irreducible, ‡5 cm hernia on barium esophagram; or (3) esophageal shortening on manometric analysis.…”

Section: Discussionmentioning

confidence: 99%

“…Our contention is that esophageal mobilization, with or without extensive mediastinal (type II) dissection [39], is usually the only procedure needed, although many feel that the Collis gastroplasty is the most effective procedure for esophageal lengthening [29,31]. In both open and laparoscopic investigations, an esophageal lengthening procedure is required in 8% to 10% of patients undergoing fundoplication for GERD [15,23,32,35].…”

Section: Discussionmentioning

confidence: 99%

The myth of the short esophagus

2004

View full text Add to dashboard Cite

show abstract

“…the occurrence of short esophagus remains controversial, as well as its preoperative diagnosis. This makes it more difficult to choose, in the operation room, the most appropriate approach for surgical correction of short esophagus that will allow a safe anti-reflux procedure 16 .…”

Section: Discussionmentioning

confidence: 99%

Thoracotomy versus transhiatal esophageal dissection: which is the best surgical approach to short esophagus?

2011

View full text Add to dashboard Cite

Purpose: To evaluate different approaches performed to obtain a more significant esophageal length. Methods: an experimental model using 28 cadavers was conceived. randomized groups: group a (n=10) underwent laparotomic transhiatal approach; group B (n=9) which differed from the first in the conduction of a wide phrenotomy and Group C (n=9) esophageal dissection was performed through a left anterolateral thoracotomy. Results: Final length variations for group a were 2.12cm and 3.29cm and for group B 3.24 cm and 3.66cm, without and with esophageal traction, respectively. in group c length gain observed was 3.81 cm. the mediastinal dissections conducted through the hiatus was considered the procedure that produced the better esophageal mobilization, and the association of wide phrenotomy significantly improved the results. Conclusions: the mediastinal dissection was the most effective to improving gain in abdominal esophagus. When toracotomy and laparotomy were compared, no significant differences were observed in the outcome.Key words: esophagus. Surgical Procedures, Operative. thoracotomy. laparotomy. Mediastinum. Dissection. cadaver. RESUMOObjetivo: Avaliar diferentes procedimentos realizados para obtenção de um ganho mais significativo no comprimento esofágico.Métodos: Um estudo experimental utilizando 28 cadáveres foi realizado. randomização dos grupos: grupo a (n=10): Submetido à abordagem laparotômica trans-hiatal; grupo B (n=9): Diferente do primeiro apenas pela realização de uma frenotomia ampla; e grupo c (n=9): a dissecção esofágica foi realizada por uma toracotomia anterior esquerda. Resultados: A variação final do comprimento para o grupo a foi 2,2 cm e 3,29 cm e para o grupo B 3,24cm e 2,66cm, medidas na ausência e presença de tração esofágica, respectivamente. no grupo c o ganho de comprimento observado foi de 3,81 cm. a dissecção mediastinal conduzida através do hiato foi considerada o procedimento de melhor mobilização esofágica e a associação de uma ampla frenotomia levou a uma significativa melhora nos resultados. Conclusões: a dissecção mediastinal foi a mais efetiva para promover o aumento do esôfago abdominal.Quando comparadas toracotomia e laparotomia, nenhuma diferença significativa foi observada no desfecho do estudo.Descritores: esôfago. Procedimentos cirúrgicos Operatórios. toracotomia. laparotomia. Mediastino. Dissecção. cadaver. Acta Cirúrgica Brasileira -Vol. 26 (3) 2011 -215Thoracotomy versus transhiatal esophageal dissection. Which is the best surgical approach to short esophagus?

show abstract

The preoperative predictability of the short esophagus in patients with stricture or paraesophageal hernia

Abstract: Manometry and esophagraphy are not reliable predictors of the short esophagus. Additional tests and/or tests combined with other parameters are needed.

Cited by 67 publications

References 12 publications

Surgical Management of Paraesophageal Hernias: Outcome and Quality of Life Analysis / with Invited Commentary

Surgical Management of Paraesophageal Hernias: Outcome and Quality of Life Analysis / with Invited Commentary

The myth of the short esophagus

Thoracotomy versus transhiatal esophageal dissection: which is the best surgical approach to short esophagus?

Contact Info

Product

Resources

About