Surgical Endoscopy

, Volume 22, Issue 10, pp 2123–2127

Short esophagus: how much length can we get?

  • Victor Bochkarev
  • Yong Kwon Lee
  • Michelle Vitamvas
  • Dmitry Oleynikov



Laparoscopic antireflux surgery requires an adequate length of intra-abdominal esophagus. Short esophagus can cause wrap herniation and poor clinical outcomes. The aim of the study is to measure maximum length of esophageal elongation with transhiatal mediastinal dissection.


This is a review of a prospective database created in the tertiary referral center between 2003 and 2006. One hundred and six patients with gastroesophageal reflux disease and suspected short esophagus on barium swallow were studied. Patients underwent antireflux surgery with extended transhiatal mediastinal dissection to elongate short esophagus. Routine measurement of intra-abdominal esophageal segment length with intraoperative esophagogastroscopy and laparoscopy was utilized to define the gastroesophageal junction (GEJ) in order to quantify total intra-abdominal esophageal length. Postoperative 24-h pH manometry, UGI series, and symptom scores were recorded to document the clinical outcomes. The aim of the dissection was to mobilize ≥3 cm of intra-abdominal esophagus.


Total esophageal elongation was achieved with a mean of 2.65 (range 2–18) cm. Resultant intra-abdominal esophageal length was measured with a mean of 3.15 (range of 3 to 5) cm. None of the preoperative “short esophagus” required Collis’ gastroplasty post extended mediastinal dissection. All preoperative symptom scores showed significant improvements with mean follow-up of 18 (9–36) months. Mean distal esophageal acid exposure normalized in all patients studied postoperatively.


Short esophagus can be safely elongated with extended mediastinal esophageal dissection. This technique can obviate the need for Collis’ gastroplasty and improve overall outcome after antireflux surgery. We recommend that extended transhiatal mediastinal dissection be performed to establish 3 cm of intra-abdominal esophagus at the time of antireflux procedures.


Short esophagus GERD Nissen fundoplication 


  1. 1.
    Raiser F, Hinder R, Mcbride P, Katada N, Filipi CJ (1995) Laparoscopic anti-reflux surgery in complicated gastroesophageal reflux disease. Semin Laparosc Surg 2:45–53Google Scholar
  2. 2.
    Madan AK, Frantzides CT, Patsavas KL (2004) The myth of the short esophagus. Surg Endosc 18(1):31–34; Epub 2003 Nov 21PubMedCrossRefGoogle Scholar
  3. 3.
    Jobe BA, Horvath KD, Swanstrom LL (1998) Postoperative function following laparoscopic collis gastroplasty for shortened esophagus. Arch Surg 133:867–874PubMedCrossRefGoogle Scholar
  4. 4.
    Peters JH, Heimbucher J, Kauer WKH, Incarbone R, Bremner CG, DeMeester TR (1995) Clinical and physiologic comparison of laparoscopic and open Nissen fundoplication. J Am Coll Surg 180:385–393PubMedGoogle Scholar
  5. 5.
    Collis JL An operation for hiatus hernia with short esophagus (1957) J Thorac Surg 34:768–778PubMedGoogle Scholar
  6. 6.
    Ritter MP, Peters JH, DeMeester TR et al (1998) Treatment of advanced gastroesophageal reflux disease with Collis gastroplasty and Belsey partial fundoplication. Arch Surg 133:523–528; discussion 528–529PubMedCrossRefGoogle Scholar
  7. 7.
    DeMeester SR, Sillin LF, Lin HW, Gurski RR (2003) Increasing esophageal length: a comparison of laparoscopic versus transthoracic esophageal mobilization with and without vagal trunk division in pigs. J Am Coll Surg 197(4):558–564PubMedCrossRefGoogle Scholar
  8. 8.
    Pearson FG, Cooper JD, Patterson GA et al (1987) Gastroplasty and fundoplication for complex reflux problems. Long-term results. Ann Surg 206:473–481Google Scholar
  9. 9.
    O’Rourke RW, Khajanchee YS, Urbach DR, Lee NN, Lockhart B, Hansen PD, Swanstrom LL (2003) Extended transmediastinal dissection: an alternative to gastroplasty for short esophagus. Arch Surg 138(7):735–740PubMedCrossRefGoogle Scholar
  10. 10.
    Oelschlager BK, Barreca M, Chang L, Oleynikov D, Pellegrini CA (2003) Clinical and pathologic response of Barrett’s esophagus to laparoscopic antireflux surgery. Ann Surg 238(4):458–464; discussion 464–466PubMedGoogle Scholar
  11. 11.
    Chang L, Oelschlager B, Barreca M, Pellegrini C (2003) Improving accuracy in identifying the gastroesophageal junction during laparoscopic antireflux surgery. Surg Endosc 17(3):390–393; Epub 2002 Nov 20PubMedCrossRefGoogle Scholar
  12. 12.
    Awad ZT, Dickason TJ, Filipi CJ, Shiino Y, Marsh RE, Tomonaga T, Tasset MR, Mittal S (1999) A combined laparoscopic-endoscopic method of assessment to prevent the complications of short esophagus. Surg Endosc 13(6):626–627PubMedCrossRefGoogle Scholar
  13. 13.
    Bremner RM, Crookes PF, Costantini M, DeMeester TR, Peters JH (1992) The relationship of esophageal length to hiatal hernia in gastroesophageal reflux disease (GERD) [abstract]. Gastroenterology 102:A45Google Scholar
  14. 14.
    Martin CJ, Cox MR, Cade RJ (1995) Collis–Nissen gastroplasty fundoplication for complicated gastro-oesophageal reflux disease. Aust N Z J Surg 62:126–129Google Scholar
  15. 15.
    Orringer MB, Sloan H (1976) Collis–Belsey reconstruction of the esophagogastric junction: indications, physiology, and technical considerations. J Thorac Cardiovasc Surg 71:295–303PubMedGoogle Scholar
  16. 16.
    Stirling MC, Orringer MB (1989) Continued assessment of the combined Collis–Nissen operation. Ann Thorac Surg 47:224–230PubMedCrossRefGoogle Scholar
  17. 17.
    Carlson MA, Frantzides CT (2001) Complications and results of primary minimally invasive antireflux procedures a review of 10,735 reported cases. J Am Coll Surg 193:428–439PubMedCrossRefGoogle Scholar
  18. 18.
    Braghetto I, Csendes A, Korn O, Buriles P, Valladares H, Cortes C, Debandi A (2004) Anatomical deformities after laparoscopic antireflux surgery. Int Surg 89(4):227–235PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Victor Bochkarev
    • 1
  • Yong Kwon Lee
    • 1
  • Michelle Vitamvas
    • 1
  • Dmitry Oleynikov
    • 1
  1. 1.Department of SurgeryUniversity of Nebraska Medical CenterOmahaUSA

Personalised recommendations