Surgical repair of Type II-IV Hiatal Hernia: frequency of True Short Esophagus and Results.

none5Background: The surgical management of type II-IV hiatal hernia is controversial. Failure to recognize the condition of short esophagus may concur to the high rate of hernia’s recurrence. We measured intraoperatively the distance between the gastro-esophageal junction (GEJ) and the hiatus (length of the abdominal esophagus) in patients undergoing surgery for type II-IV hiatus hernias. Methods: 34 patients underwent minimally invasive surgery. After isolation of the GEJ and resection of the sac, the position of the gastric folds was localized endoscopically and two clips were applied. The distance between the clips and the diaphragm (abdominal esophagus) was measured with a dedicated ruler after mediastinal dissection. In case of abdominal esophagus 1.5 cm a Collis-Nissen was performed. Results: 17 (50%) fl oppy Nissen and 17 (50%) thoracoscopic Collislaparotomic Nissen were performed. In the latter group, (all type III-IV hernia), after mediastinal mobilization the length of the abdominal esophagus was ≤1.5 cm. Post-operative mortality was 5.8% and morbility 17.6%. Global results (median follow up 48 months) were excellent in 43.8%, good in 50%, fair in 3.1%, and poor in 3.1%. Hiatal hernia relapse occurred in 3.1% of patients. Discussion: True short esophagus is present in 50% of type III-IV and in none of type II hiatus hernia. The intraoperative measurement of the length of the abdominal esophagus is an objective method for recognizing these patients. Disclosure: All authors have declared no confl icts of interest.noneLugaresi M; Aramini B; Ruffato A; Mattioli S;O Perrone.Lugaresi M; Aramini B; Ruffato A; Mattioli S;O Perrone