Transhiatal esophagectomy

Last revised by Craig Hacking on 28 Aug 2018

Transhiatal esophagectomy is a type of esophagectomy, a surgery that removes the distal esophagus, usually for esophageal carcinoma.

Removal of the esophagus can be performed through the chest wall (a transthoracic esophagectomy), but the thoracotomy is a major component of patient pain and complication. A transhiatal approach, avoiding the thoracotomy, is associated with fewer pulmonary complications.

The transhiatal approach also substitutes a thoracic-level anastomosis with a cervical-level anastomosis.


  • suparumbilical incision and distal esophageal dissection
  • incision parallel to the left sternocleidomastoid for dissection of the proximal esophagus
  • careful blunt dissection of the esophagus in the mediastinum through the hiatus
  • cervical esophagus is transected
  • partial gastrectomy
  • esophagus removed
  • gastric pull up or gastric conduit (e.g. colon, jejunum) formed
  • anastomotic leak at the cervical anastomosis
  • anastomotic stricture
  • recurrent laryngeal nerve injury

Differential diagnosis

The imaging differential diagnosis includes

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