The myth of the short esophagus

Background: The advent of laparoscopic surgery has increased the number of fundoplications performed today. With the increase in laparoscopic fundoplications, the reports of short esophagus continue to increase. This investigation was undertaken to review our data regarding the entity described as “short esophagus.” Method: All charts of patients who had laparoscopic fundoplications performed from 1991 to 2000 were reviewed. Patients with laparoscopic fundoplications received esophagrams at 3 months postoperatively and then at 6 months. Results: A total of 628 fundoplications were performed, with 351 requiring hiatal hernia repair. After appropriate esophageal mobilization was performed, no further esophageal lengthening procedure was needed. There were 4 conversions, 16 recurrences, and 7 complications, and no deaths. Recurrences were due to “slipped fundoplications” (n = 3), ineffective valves (n = 5), and hiatal hernia disruptions (n = 8). Conclusions: In our series of fundoplications and hiatal hernia repairs, no short esophagus was noted. With proper esophageal mobilization, clinically the entity described as “short esophagus” may not exist.