Aim of this study was to define frequency, patterns and surgical treatment of the intrathoracic migration of the ge- junction and short oesophagus in patients operated upon for GERD. Methods 319 pts were grouped in 1980–91 and 1992–2003 periods. Preoperatively patients underwent a complete clinical-instrumental work up. The various degrees of the intrathoracic migration of the GEJ were classified according to barium swallow. Intraoperatively, the eventual esophageal shortening was assessed in the 1st period (open surgery) subjectively by the surgeon and in the 2nd period (mini-invasive surgery) by intraoperative esophagoscopy. In both periods Nissen fundusplication, Collis-Belsey and Collis-Nissen were adopted according to the intraoperative assessment to replace the g-e-junction into the abdomen without tension. Results Preoperatively various degrees of esophageal shortening were radiologically diagnosed in 40.3% in the 1st period and in 63% in the 2nd period. The Collis gastroplasty was performed in 29.5% in the 1st and in 23.5% in the 2nd period. Radiology was a strong predictor of the necessity to elongate the esophagus. In the 1st period results (median FU 84, 12–252 months) of standard Nissen and of Collis + Belsey or Nissen were satisfactory, respectively, in 84.8% and 75%. In the 2nd period (median FU 48, 12–126 months) results were satisfactory in 96.8% of standard Nissen and in 80% of Collis + Nissen. Conclusions In surgery for severe GERD, the Collis procedure is required in 23% of operations; radiology helps to plan surgery; intraoperative endoscopy avoids unnecessary esophageal lengthening. Surgery for short esophagus needs dedicated demanding procedures
The surgical treatment of the intrathoracic migration of the GE junction and short esophagus in GERD.
MATTIOLI, SANDRO;LUGARESI, MARIALUISA;DI SIMONE, MASSIMO PIERLUIGI;
2004
Abstract
Aim of this study was to define frequency, patterns and surgical treatment of the intrathoracic migration of the ge- junction and short oesophagus in patients operated upon for GERD. Methods 319 pts were grouped in 1980–91 and 1992–2003 periods. Preoperatively patients underwent a complete clinical-instrumental work up. The various degrees of the intrathoracic migration of the GEJ were classified according to barium swallow. Intraoperatively, the eventual esophageal shortening was assessed in the 1st period (open surgery) subjectively by the surgeon and in the 2nd period (mini-invasive surgery) by intraoperative esophagoscopy. In both periods Nissen fundusplication, Collis-Belsey and Collis-Nissen were adopted according to the intraoperative assessment to replace the g-e-junction into the abdomen without tension. Results Preoperatively various degrees of esophageal shortening were radiologically diagnosed in 40.3% in the 1st period and in 63% in the 2nd period. The Collis gastroplasty was performed in 29.5% in the 1st and in 23.5% in the 2nd period. Radiology was a strong predictor of the necessity to elongate the esophagus. In the 1st period results (median FU 84, 12–252 months) of standard Nissen and of Collis + Belsey or Nissen were satisfactory, respectively, in 84.8% and 75%. In the 2nd period (median FU 48, 12–126 months) results were satisfactory in 96.8% of standard Nissen and in 80% of Collis + Nissen. Conclusions In surgery for severe GERD, the Collis procedure is required in 23% of operations; radiology helps to plan surgery; intraoperative endoscopy avoids unnecessary esophageal lengthening. Surgery for short esophagus needs dedicated demanding proceduresI documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
