title: Incidence of true short esophagus among patients submitted to laparoscopic Nissen fundoplication.
abstract: BACKGROUND
  The last two decades have observed development of surgical treatment of benign conditions of the gastroesophageal junction (GEJ), including anti-reflux surgery, due to the growing popularity of the laparoscopic approach. Migration of the fundoplication band and recurrent hiatal hernia are a result of the lack of correct diagnosis and appropriate management of the so-called short esophagus. According to various authors, short esophagus is present in up to 60% of patients qualified for anti-reflux surgery. However, some researchers question the existence of this condition.
  
  
  OBJECTIVE
  To analyze the prevalence of short esophagus in patients subjected to laparoscopic Nissen fundoplication.
  
  
  METHODS
  The study included 202 patients who were subjected to laparoscopic Nissen fundoplication.
  
  
  RESULTS
  As many as 96% of the patients qualified for the surgical treatment showed supradiaphragmatic location of the high pressure zone. The extent of GEJ protrusion ranged from 0 cm to 3 cm (mean: 2 cm). The extent of dissection within the mediastinum was determined by the level of GEJ protrusion, and ranged from 5 cm to 12 cm (mean: 6 cm). Upon complete mobilization of the esophagus within the mediastinum, no cases of significantly shortened esophagus, precluding downward retraction of at least a 2.5-cm segment below the diaphragmatic crura, were documented. Therefore, none of the patients required Collis gastroplasty.
  
  
  CONCLUSIONS
  The presence of "true" short esophagus is a sporadic finding among patients qualified for anti-reflux surgery. Mediastinal dissection of the esophagus and its mobilization at an appropriate, individually defined level seems a sufficient treatment in the vast majority of these patients.
authors.affiliation: Second Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Migaczewski
authors.affiliation: Second Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Zub-Pokrowiecka
authors.affiliation: Second Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Agata
authors.initials: A
authors.lastname: Grzesiak-Kuik
authors.affiliation: Second Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Pędziwiatr
authors.affiliation: Second Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Major
authors.affiliation: Second Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Mateusz
authors.initials: M
authors.lastname: Rubinkiewicz
authors.affiliation: Second Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Winiarski
authors.affiliation: Second Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Natkaniec
authors.affiliation: Second Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Budzyński
keywords: Nissen fundoplication; antireflux surgery; laparoscopy; short esophagus