Esophageal shortening during the era of laparoscopic surgery

被引:25
作者
Awad, ZT [1 ]
Mittal, SK [1 ]
Roth, TA [1 ]
Anderson, PI [1 ]
Wilfley, WA [1 ]
Filipi, CJ [1 ]
机构
[1] Creighton Univ, Sch Med, Dept Surg, Omaha, NE 68131 USA
关键词
D O I
10.1007/s002680020075
中图分类号
R61 [外科手术学];
学科分类号
摘要
An effective method for determining the presence of a short esophagus preoperatively would be helpful to surgeons. In this study 260 patients underwent primary laparoscopic antireflux surgery: 44 of them were suspected to have esophageal shortening on the basis of (1) Barrett's esophagus or evidence of peptic stricture formation on endoscopy; (2) an irreducible hiatal hernia greater than or equal to 5 cm in length on upright barium esophagram; or (3) a short esophagus on manometric analysis, defined as 2 SD below normal for height. Six patients without preoperative criteria required extensive esophageal mobilization and intraoperative endoscopic/laparoscopic assessment. Preoperative results were then compared with intraoperative esophageal length assessments. Altogether, 13 patients (5% of the whole series) underwent a lengthening procedure: left thoracoscopically assisted laparoscopic Collis gastroplasty (n = 11) or open transthoracic Collis gastroplasty (n = 2) plus antireflux repair (Nissen fundoplication in 9 and Toupet repair in 4). Among the preoperative tests, endoscopy had the highest sensitivity rate (61%); a combination of tests resulted in an increase in the specificity (63-100%) without a corresponding increase in sensitivity (28-42%), Preoperative testing is thus useful for predicting the need for an esophageal lengthening procedure. Endoscopy is the best screening test for the short esophagus. A well planned prospective trial to test the reliability of each test is needed.
引用
收藏
页码:558 / 561
页数:4
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