Frequency of true short oesophagus in non axial hiatus hernia (NAHH)

Background/Objectives: The length of the abdominal oesophagus (AO) in patients undergoing surgery for NAHH is still controversial. This lack of information may concur to the high rate of hernia’s recurrence after repair. We measured intra operatively the distance between the gastrooesophageal junction (GOJ) and the hiatus in patients undergoing surgery for NAHH. Materials & Methods: 34 patients (26 females 76.4%, mean age 65.3 range 41-84 yrs) underwent a laparoscopic approach. After full isolation of the GOJ and complete 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 apex of the diaphragm was measured with a dedicated ruler before and after the esophageal dissection. In case of AO <1.5 cm a Collis-Nissen was performed. Results: Mean duration of symptoms was 100 months (r. 12-360), reflux symptoms were moderate in 21/34 (61.7%), severe in 13/34 (38.3%), oesophagitis was present in 16/34 (47%). NAHH were type II (para-oesophageal) in 4 (11.8%), type III 24 (mixed) (70.6%), type IV (organo-axial volvolus) in 6 (17.6%). Before dissection the AO was ≤1.5 cm in 26 pts (76.4%), median length of the mediastinal dissection was 10 cm (range 6-13 cm). After dissection AO was still <1,5 cm in 17 (50%), respectively in 0/4 of type II, in 13/24 of type III and in 4/6 of type IV. No difference was calculated between AO longer or shorter than 1.5 cm with respect to duration and severity of symptoms and oesophagitis. 17 pts (50%) underwent the Collis-Nissen. Conclusions/Uploads: Short oesophagus is present in 50% of NAHH , mainly in type III and IV. The intra operative measurement of the length of the AO is an objective method for recognizing these cases. Disclosure: All authors have declared no conflicts of interest.