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October 1957

Short Esophagus: Mechanism of Pain, and Surgical Therapy

Author Affiliations

From the Department of Thoracic Surgery, The Cleveland Clinic Foundation and The Frank E. Bunts Educational Institute.

AMA Arch Surg. 1957;75(4):639-646. doi:10.1001/archsurg.1957.01280160149019

Akerlund's classification1 of hiatus hernias consisted of three categories: paraesophageal, pulsion type, and short esophagus. Although other descriptive terms have been applied to hiatus hernias, Akerlund's terminology is in common use today. The surgeon, however, recognizes two major types of hiatus hernia: (1) that created by pulsion—a normal length of esophagus that is forced into the mediastinum by increased intra-abdominal pressure, and (2) that created by traction—a progressive shortening of the esophagus. It matters little whether the pulsion type of hernia is perihiatal (Sweet2), paraesophageal (Akerlund1), or sliding (Allison3); in all types the basic mechanism is the same, and the method of surgical repair is identical. It is, however, of more than academic interest that the surgeon recognize the hernia that is produced by traction and is associated with significant shortening of the esophagus.

Conflicting views appear in the voluminous published reports in which this subject