Transhiatal oesophagectomy

Transhiatal oesophagectomy is a type of oesophagectomy, a surgery that removes the distal oesophagus, usually for oesophageal carcinoma.

Removal of the oesophagus can be performed through the chest wall (a transthoracic oesophagectomy), 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.

Procedure

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

Differential diagnosis

The imaging differential diagnosis includes

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Article Information

rID: 43385
Synonyms or Alternate Spellings:
  • Transhiatal esophagectomy
  • Transhiatal oesophagectomies

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