The frequency of true short oesophagus in type II–IV hiatal hernia

OBJECTIVES: 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%