title: Increasing esophageal length: a comparison of laparoscopic versus transthoracic esophageal mobilization with and without vagal trunk division in pigs.
abstract: BACKGROUND
  New laparoscopic techniques allow both mediastinal mobilization and performance of a Collis gastroplasty when necessary, and the utility of a transthoracic approach is questioned. The aim of this study was to compare the increase in esophageal length achievable with laparoscopic and transthoracic esophageal mobilization in pigs, and to assess the impact of vagal trunk division on esophageal length.
  
  
  METHODS
  Baseline esophageal length was obtained in 20 farm pigs by measuring the distance between a stitch placed in the esophagus to a K-wire placed in a vertebral body. Subsequently, laparoscopic and then transthoracic mediastinal mobilization of the esophagus were performed in 15 pigs and the length gain after each procedure recorded. In 7 of 15 animals, the vagal nerve trunks were divided after esophageal mobilization and the increase in esophageal length measured. In five animals, vagal trunk division was performed without earlier esophageal mobilization.
  
  
  RESULTS
  Esophageal length gain after laparoscopic mobilization (median 4 mm) was significantly less than that after transthoracic mobilization (median 12 mm, p < 0.0001). Unilateral vagal nerve transection resulted in a median 2.5 mm of esophageal length gain compared with a median of 6.25 mm with division of both vagal trunks. Maximal esophageal lengthening (median 18.5 mm) occurred with a combination of esophageal mobilization and bilateral vagal trunk division.
  
  
  CONCLUSIONS
  Esophageal length gain after transthoracic mobilization in normal pigs is significant, and would likely be even greater in patients with gastroesophageal reflux disease with concomitant mediastinal inflammation. Transthoracic mobilization alone likely will allow successful reduction of the gastroesophageal junction below the diaphragm in many patients who might otherwise require a Collis gastroplasty.
authors.affiliation: Department of Cardiothoracic Surgery, The University of Southern California, Keck School of Medicine, Los Angeles, CA, USA.
authors.forename: Steven R
authors.initials: SR
authors.lastname: DeMeester
authors.forename: Lelan F
authors.initials: LF
authors.lastname: Sillin
authors.forename: Harrison W
authors.initials: HW
authors.lastname: Lin
authors.forename: Richard R
authors.initials: RR
authors.lastname: Gurski
mesh_terms: D000818:Animals; D004943:Esophagogastric Junction / Q000601:surgery; D004947:Esophagus / Q000473:pathology* / Q000601:surgery; D005764:Gastroesophageal Reflux / Q000473:pathology / Q000601:surgery*; D015391:Gastroplasty; D010535:Laparoscopy; D013552:Swine; D014630:Vagus Nerve / Q000601:surgery