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.
- 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
- anastomotic leak at the cervical anastomosis
- anastomotic stricture
- recurrent laryngeal nerve injury
The imaging differential diagnosis includes
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- 2. Flanagan JC, Batz R, Saboo SS et-al. Esophagectomy and Gastric Pull-through Procedures: Surgical Techniques, Imaging Features, and Potential Complications. Radiographics. 2016;36 (1): 107-21. doi:10.1148/rg.2016150126 - Pubmed citation