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Intrathoracic Periesophageal Fundoplication for Short Esophagus: A 20-Year Experience  Francesco Volonté, MD, Jean-Marie Collard, MD, PhD, Louis Goncette,

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Presentation on theme: "Intrathoracic Periesophageal Fundoplication for Short Esophagus: A 20-Year Experience  Francesco Volonté, MD, Jean-Marie Collard, MD, PhD, Louis Goncette,"— Presentation transcript:

1 Intrathoracic Periesophageal Fundoplication for Short Esophagus: A 20-Year Experience 
Francesco Volonté, MD, Jean-Marie Collard, MD, PhD, Louis Goncette, MD, Christian Gutschow, MD, Paolo Strignano, MD  The Annals of Thoracic Surgery  Volume 83, Issue 1, Pages (January 2007) DOI: /j.athoracsur Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

2 Fig 1 Operative activity over time, 1986 to Numbers in boxes indicate number of patients. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

3 Fig 2 Upper gastrointestinal series in two different patients with the gastroesophageal junction (white arrows) above the diaphragm (dotted lines), whereas the distal esophagus is not tortuous. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

4 Fig 3 Four intraoperative views: the white arrows indicate (A) the irreducible gastroesophageal junction, (B) the further enlargement of the hiatal sling, (C) the 3 to 4 cm intrathoracic fundoplication, and (D) the multiple anchoring sutures to the hiatal sling. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

5 Fig 4 Postoperative barium swallow study showing the intrathoracic fundoplication. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

6 Fig 5 Mean percent time esophageal pH greater than 4: preoperative (blank columns) and postoperative (black columns) esophageal pH results in the total (left), upright (center), and supine (right) periods of recording. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

7 Fig 6 Lower esophageal sphincter (LES) resting pressure before (left) and after (right) intrathoracic fundoplication. Horizontal lines indicate ± SD; black bars indicate ± SEM; white boxes indicate mean. (preop = preoperative; postop = postoperative.) The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

8 Fig 7 Percentage of patients who experienced spontaneous gastric perforation in our historical series of 16 fundoplications and in the present series of 84 fundoplications. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

9 Fig 8 Barium swallow studies before any antireflux operation, showing (left) a 5-cm irreducible hiatal hernia; and after laparoscopic fundoplication made in another institution, showing (right) intrathoracic migration of a perigastric wrap into the chest. White arrows show the irreducible gastroesophageal. A remedial intrathoracic fundoplication was done for heartburn and dysphagia. (Dashed lines = diaphragm.) The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions


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