Techniques of Esophageal Lengthening

The concept of a short esophagus defined as less than 2.5 cm of intra-abdominal esophageal is still a highly debated topic among benign UGI surgeons. Giant hiatal hernias and peptic strictures are a few conditions associated with lack of intra-abdominal esophageal length. All paraesophageal hernia operations necessitate adequate mediastinal esophageal mobilization until the inferior pulmonary vein. However, if despite this maneuver, a short esophagus is encountered, then a lengthening procedure is recommended to reduce the risk of a slipped wrap and hernia recurrence. Several options for esophageal lengthening are available including a left transthoracic, or a right transthoracic Collis stapled approach, modified collis gastroplasty and wedge gastroplasty.