Thoracoscopic vagal-sparing esophagectomy and colonic interposition for caustic stricture

Abstract

Minimally invasive esophagectomy is an increasing trend in surgery. Thoracoscopic esophagectomy is applicable and an alternative procedure to conventional esophagectomy in patients especially with end-stage benign diseases like caustic stricture. A 33-year-old female patient was admitted to the department of general surgery with dysphagia. The patient was suffering from caustic stricture due to ingestion of hydrochloric acid. A totally thoracoscopic and laparoscopic vagal-sparing esophagectomy and colonic interposition was performed. As a more physiologic alternative, vagal-sparing esophagectomy is the ideal operation for these patients.

Minimal access surgery of corrosive and thermal strictures of the foregut

“…[ 12 , 19 , 23 , 24 , 26 , 34 , 36 , 41 ] Most are isoperistaltic, based on left colic vessels (especially its ascending branch), favored owing to its unvarying anatomy, optimal luminal diameter, presence of marginal arcade and robust blood supply. [ 12 , 19 , 23 , 32 , 35 , 36 , 41 , 55 , 56 ] Long conduits, including distal 15 cm of ileum, can be based on left colic vessels. [ 26 , 32 , 56 ] Ileo-colic valve prevents reflux proving advantageous.…”

“…Thoracoscopic oesophagectomy (TE) is conventionally performed in the left lateral decubitus position, using 3-5 ports. [ 11 , 13 , 14 , 21 , 29 , 36 , 51 , 58 ] Surgeon and assistant (s) stand to the patients’ right and left, respectively, while the monitor is placed cranially on the left. Ports (10/5 mm) for camera and lung retractor are placed anterior to mid-axillary line, in the 7/8 th intercostal space (ICS) and 5 th ICS, respectively.…”

“…[ 13 , 14 , 21 , 29 ] Some site the camera port inferiorly and working ports cranially, on either side. [ 11 , 36 ]…”

“…[ 32 , 54 , 58 ] Double lumen tube or bronchial blocker is chosen for conventional TE, to deflate the right lung. [ 11 , 13 , 14 , 25 , 36 ] Single lumen tube may also be negotiated into the left main bronchus for the purpose. [ 29 ] Though TE in prone position obviates such needs, it is wiser to keep the provision available, should a need arise.…”

“…[ 11 , 13 , 14 , 16 – 18 , 40 ] Magnification also facilitates vagal preservation, although, its function remains ambivalent as fibrosis causes functional autovagotomy. [ 2 , 17 , 25 , 26 , 36 ] Care is taken not to breach the phreno-oesophageal membrane till the last lest air escapes into the abdomen. [ 13 , 40 ]…”