The short esophagus: intraoperative assessment of esophageal length

Objective: To define the frequency and predictors of short esophagus in a case series of patients undergoing antireflux surgery. Method: An observational prospective study from September 10, 2004, to October 31, 2006, was performed at 8 centers. The distance between the esophagogastric junction as identified by intraoperative esophagoscopy and the apex of the diaphragmatic hi-atus was measured intraoperatively before and after esophageal mediastinal dissec-tion; a distance of 1.5 cm was arbitrarily determined to categorize cases as long(.1.5 cm) or short (#1.5 cm). Results: One hundred eighty patients were enrolled; the mean age of patients was 49.36 15.3 years. At the first measurement (after isolation of the esophagogastric junc-tion), the median distance between the esophagogastric junction and the apex of the hiatus was equal to or shorter than 1.5 cm in 68 (37.7%) patients; at the second mea-surement (after full mediastinal isolation), the measurement of the distance was still shorter than 1.5 cm in 34 (18.8%) patients and between 1.5 and 2.5 cm in 24(13.4%) patients. The median length of the mediastinal esophageal dissection was 6 cm (range 1–12 cm). An esophageal lengthening procedure was performed in 26(14.4%) patients. The duration of symptoms (P 5 .047), the General Health domain of the SF-36 questionnaire (P 5 .001), and an x-ray barium swallow (P 5 .000) are predictive factors for a ‘‘true’’ short esophagus. Conclusions: True short esophagus is present in about 20% of patients undergoing routine antireflux surgery. Radiology, severity, and duration of symptoms are predic-tors of true foreshortening