Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Via G. Massarenti 9, Bologna, Italy.
Division of Thoracic Surgery, Maria Cecilia Hospital, Via Corriera 1, Cotignola, Ravenna, Italy.
Ann Surg. 2021 Aug 1;274(2):331-338. doi: 10.1097/SLA.0000000000003582.
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.
探讨胃食管反流病（GERD）或食管裂孔疝（HH）手术中真正短食管（TSE）的频率和长期结果。
在 GERD/HH 手术中 TSE 的存在及其治疗存在争议。采用或不采用专门针对 TSE 的手术技术，均可取得满意的长期效果。
在 311 例接受微创 GERD/HH 手术的连续患者中，测量最大胸腔食管游离后内镜定位的胃食管交界处（GEJ）和膈裂孔顶点之间的距离。如果腹部长度>1.5cm，则行标准 Nissen 胃底折叠术（SN）；如果存在 TSE（腹部长度<1.5cm），则在老年患者中行 Collis-Nissen（CN）或胃环绕胃底折叠术（SASF）。胃底折叠术的上缘固定在裂孔下方，但位于 GEJ 上方。记录患者的症状、放射影像学和内镜数据。
在胸腔内食管游离（中位数 9cm）后，311 例患者中有 31.8%诊断为 TSE。在中位数为 96 个月（309 例患者）的随访中，3.2%的患者放射影像学诊断为 HH 复发，分别有 45.6%、44.3%、6.2%和 3.9%的患者获得了极好、好、尚可和差的结果，SN（68.5%）、CN（26.4%）和 SASF（5.2%）之间无显著差异。
在常规接受 GERD/HH 手术的患者中，TSE 占 31.8%。在存在 TSE 的情况下，根据既定手术原则施行 CN 和 SASF 可能获得类似的满意结果。这一发现需要前瞻性多中心研究加以证实。
