Lal P, Tang P, Sarvepalli S, et al. - Given a lack of an objective test to identify a shortened esophagus before surgical hiatal hernia repair, researchers here used a unique MELH ratio to determine the presence of a shortened esophagus and examined the role of esophageal length in hiatal hernia recurrence. Via conducting a retrospective review, they recognized 254 patients with hiatal hernia who underwent preoperative esophageal manometry and either an open hernia repair with Collis gastroplasty and fundoplication (with Collis) or laparoscopic repair and fundoplication without Collis gastroplasty (without Collis) from 2005-2016. Outcomes suggest the predictive value of the MELH ratio for a shortened esophagus preoperatively. The risk of recurrence was higher in correlation with lower MELH and mitigation of the risk associated with shortened esophagus can be achieved with an esophageal lengthening procedure such as Collis gastroplasty.