Open Technique for Transhiatal Esophagectomy

Abstract

Open transhiatal esophagectomy is a well-established approach that has been shown to be effective and safe with acceptable morbidity and mortality. Indications for transhiatal esophagectomy include both benign and malignant diseases with esophageal carcinoma comprising the majority of cases. Following an appropriate preoperative workup and possible neoadjuvant therapy, the operation is performed in the supine position with access to the left neck, chest, and abdomen. The essential phases of the operation include mobilization of the gastric conduit, pyloric drainage procedure, initial mediastinal dissection, cervical esophageal mobilization, completion of the mediastinal dissection, esophageal and gastric transection with creation of the gastric conduit, and finally cervical esophagogastric anastomosis. Postoperatively the patients are immediately started on an aggressive regimen of pulmonary toilet and physical therapy and tube feedings. Several well-recognized complications that can occur during or after esophagectomy include tracheal tears, major intrathoracic bleeding, recurrent laryngeal nerve injury, anastomotic leak, and thoracic duct leak.