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Secondary Short Esophagus

Laparoscopic antireflux procedures have recently led to a renewed interest in antireflux surgery. This will inevitably increase the numbers of patients having a short esophagus who are referred to surgeons for treatment. The actual incidence of the short esophagus is estimated to be approximately 10% of patients undergoing antireflux surgery. Of this group, 7% can be appropriately managed with extensive mediastinal mobilization of the esophagus to achieve the required esophageal length. The remaining 3% (true shortened esophagus) require an aggressive surgical approach. Secondary short esophagus is intraoperatively defined as less than 2.5 cm to 3 cm of intraabdominal esophageal length after extensive mediastinal mobilization. The Collis-Nissen procedure has an established excellent long-term success rate for this complex problem. Evenhough, it is a non-physiologic treatment for a complex problem and requires long-term follow-up.