Technical Options and Approaches to Lengthen the Shortened Esophagus

Failure to recognize a short esophagus during paraesophageal hernia repair can lead to poor functional outcomes and increased recurrence rates. Diagnosis is usually done intraoperatively when less than 2 to 3 cm of esophagus lie in the intraabdominal position. If aggressive esophageal mediastinal mobilization is unable to lengthen the esophagus, the surgeon should perform an esophageal lengthening procedure. A modified Collis gastroplasty is most commonly used and can be performed through a variety of transabdominal or transthoracic approaches. These procedures are safe, durable, and associated with good long-term outcomes. Patient selection and safe surgical technique are key in avoiding complications.