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

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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 265-271 (January 2007) DOI: 10.1016/j.athoracsur.2006.07.056 Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Operative activity over time, 1986 to 2005. Numbers in boxes indicate number of patients. The Annals of Thoracic Surgery 2007 83, 265-271DOI: (10.1016/j.athoracsur.2006.07.056) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

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 2007 83, 265-271DOI: (10.1016/j.athoracsur.2006.07.056) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

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 2007 83, 265-271DOI: (10.1016/j.athoracsur.2006.07.056) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Postoperative barium swallow study showing the intrathoracic fundoplication. The Annals of Thoracic Surgery 2007 83, 265-271DOI: (10.1016/j.athoracsur.2006.07.056) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

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 2007 83, 265-271DOI: (10.1016/j.athoracsur.2006.07.056) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

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 2007 83, 265-271DOI: (10.1016/j.athoracsur.2006.07.056) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

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 2007 83, 265-271DOI: (10.1016/j.athoracsur.2006.07.056) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

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 2007 83, 265-271DOI: (10.1016/j.athoracsur.2006.07.056) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions