title: The frequency of true short oesophagus in type II-IV hiatal hernia.
abstract: OBJECTIVE
  The misdiagnosis of short oesophagus may occur on recurrence of the hernia after surgery for type II-IV hiatal hernia (HH). The frequency of short oesophagus in type II-IV hernia is undefined. The aim of this study was to assess the frequency of true short oesophagus in patients undergoing surgery for type II-IV hernia.
  
  
  METHODS
  Thirty-four patients with type II-IV hernia underwent minimally invasive surgery. After full isolation of the oesophago-gastric junction, the position of the gastric folds was localized endoscopically and two clips were applied in correspondence. The distance between the clips and the diaphragm (intra-abdominal oesophageal length) was measured. When the intra-abdominal oesophagus was <1.5 cm after oesophageal mobilization, the Collis procedure was performed. After surgery, patients underwent a follow-up, comprehensive of barium swallow and endoscopy.
  
  
  RESULTS
  After mediastinal mobilization (median 10 cm), the intra-abdominal oesophageal length was >1.5 cm in 17 patients (4 type II, 11 type III and 2 type IV) and ≤ 1.5 cm in 17 patients (13 type III and 4 type IV hernia). No statistically significant differences were found between patients with intra-abdominal oesophageal length > or ≤ 1.5 cm with respect to symptoms duration and severity. Global results (median follow-up 48 months) were excellent in 44% of patients, good in 50%, fair in 3% and poor in 3%. HH relapse occurred in 3%.
  
  
  CONCLUSIONS
  True short oesophagus is present in 57% of type III-IV and in none of type II HHs. The intraoperative measurement of the submerged intra-abdominal oesophagus is an objective method for recognizing these patients.
authors.affiliation: Division of Thoracic Surgery, Center for Study and Therapy of Diseases of Oesophagus, Alma Mater Studiorum University of Bologna, GVM Care and Research, Cotignola, Italy.
authors.forename: Marialuisa
authors.initials: M
authors.lastname: Lugaresi
authors.forename: Sandro
authors.initials: S
authors.lastname: Mattioli
authors.forename: Beatrice
authors.initials: B
authors.lastname: Aramini
authors.forename: Frank
authors.initials: F
authors.lastname: D'Ovidio
authors.forename: Massimo Pierluigi
authors.initials: MP
authors.lastname: Di Simone
authors.forename: Ottorino
authors.initials: O
authors.lastname: Perrone
mesh_terms: D000368:Aged; D001466:Barium Sulfate; D003287:Contrast Media; D003964:Diaphragm / Q000473:pathology; D004943:Esophagogastric Junction / Q000473:pathology / Q000601:surgery; D004945:Esophagoscopy / Q000379:methods; D004947:Esophagus / Q000002:abnormalities* / Q000000981:diagnostic imaging; D005260:Female; D005764:Gastroesophageal Reflux / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods; D006551:Hernia, Hiatal / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007430:Intraoperative Care; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D001466:Barium Sulfate