Two Thousand Transhiatal Esophagectomies

Orringer, Mark B.; Marshall, Becky; Chang, Andrew C.; Lee, Jung Hwa; Pickens, Allan; Lau, Christine L.

doi:10.1097/sla.0b013e31814697f2

Cited by 449 publications

(308 citation statements)

References 26 publications

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“…The constrict space, development of local fibrosis and angulation of the stomach may lead to these results. Some authors opted to resect the manubryum and part of the clavicle in order increase this space [13,21] .…”

Section: Discussionmentioning

confidence: 99%

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Non-conventional surgical approach to achalasia: mucosectomy and endomuscular pull-through

Aquino¹,

Said²,

Camargo³

2017

MIS

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Aim: Transhiatal esophagectomy is a therapeuthic option for the treatment of end-stage achalasia that avoids the complications of a thoracotomy. This technique; however, is still linked to some degree of morbimortality especially due to pleuromediastinal complications. Esophageal mucosectomy and endomuscular pull-through could avoid these complications. This study aims to evaluate the short and long-term outcomes of esophageal mucosectomy and endomuscular pull-through in a series of patients with advanced megaesophagus. Methods: We retrospectively studied 115 patients with end-stage achalasia that underwent esophageal mucosectomy and endomuscular pull-through. Digestive tract reconstruction was accomplished most times using the stomachthourgh the muscular tunnel. Outcomes were evaluated in a short and long-term follow-up based on clinical, endoscopic and tomographic evaluation. Results: Anastomotic leak or stenosis was present in 27%. Pleural efusion was noticed in 11% and pneumonia in 9%. Mortality was 1.7%. Long-term follow-up (over 10 years) was possible in 42 patients. Excellent and good clinical results were obtained in 83% of the patients. Conclusion: Esophageal mucosectomy and endomuscular pull-through is a valuable procedure for the treatment of end-stage achalasia. It shows a low rate of complications and good outcomes at long-term follow-up. Key words:Achalasia, esophagectomy, megaesophagus, mucosectomy ABSTRACTArticle history:

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Section: Discussionmentioning

confidence: 99%

“…However, a high level of morbimortality is expected when a hemorrhage occurs [11,12,20,21] . Large vessels such as the azygos vein or direct branches from the aorta may be injured and in case of pleural lesion may lead to hemothorax in 25% of the cases.…”

Section: Discussionmentioning

confidence: 99%

Non-conventional surgical approach to achalasia: mucosectomy and endomuscular pull-through

Aquino¹,

Said²,

Camargo³

2017

MIS

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“…Incidence in several studies has ranged from 0% to 50%, with most authors reporting a high incidence of this complication 1,4,7,8 . Although these fistulas usually have a favorable course, about 2% of cases can have a catastrophic outcome 6 . In cases in which the fistula does not lead directly to death, it may compromise quality of life, interfere with resumption of feeding, require laborious local care, and prolong hospital stay.…”

Section: Introductionmentioning

confidence: 99%

Cervical esophagogastric anastomosis with invagination after esophagectomy

et al. 2012

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PURPOSE: To evaluate the incidence of fistula and stenosis of the cervical esophagogastric anastomosis with invagination of the proximal esophageal stump into the stomach after subtotal esophagectomy. METHODS:We studied 54 patients who underwent subtotal esophagectomy, 45 (83.3%) patients with carcinoma and nine (16.6%) with advanced megaesophagus. In all cases the cervical esophagogastric anastomosis was performed with the invagination of the proximal esophageal stump inside the stomach. RESULTS:Three (5.5%) patients had a fistula at the esophagogastric anastomosis, two of whom with minimal leakage of air or saliva and with mild clinical repercussion; the third had a low output fistula that drained into the pleural space, and this patient developed empyema that showed good progress with drainage. Fibrotic stenosis of anastomosis occurred in thirteen (24%) subjects and was treated successfully with endoscopic dilatation. CONCLUSION:Cervical esophagogastric anastomosis with invagination of the proximal esophageal stump into the stomach tube presented a low rate of esophagogastric fistula and stenosis, thus becoming an attractive option for the reconstruction of alimentary transit after subtotal esophagectomy. Key words: Esophagus. Esophagectomy. Constriction, Pathologic. Anastomotic Leak, Gastroplasty. RESUMOOBJETIVO: Avaliar a incidência de fístula e estenose da anastomose esofagogástrica cervical com invaginação do coto esofágico proximal no interior do estômago após esofagectomia subtotal. MÉTODOS:Foram estudados 54 pacientes submetidos à esofagectomia subtotal, 45 (83,3%) com carcinoma e nove (16,6%) com megaesôfago chagásico avançado. Em todos os casos, a anastomose esofagogástrica cervical foi realizada com invaginação do coto esofágico proximal no interior do estômago. RESULTADOS:Três (5,5%) pacientes apresentaram fístula, dois deles com saída mínima de ar e saliva pela incisão cervical que evoluíram com rápida cicatrização; o terceiro apresentou fístula de pequeno débito que drenou para o espaço pleural causando empiema que teve boa evolução após drenagem. Treze (24%) doentes apresentaram estenose fibrótica e foram tratados com sucesso com dilatação endoscópica. CONCLUSÃO:A anastomose esofagogástrica cervical com invaginação do coto esofágico proximal no interior do estômago apresentou baixa incidência de fístula e estenose tornando-se opção atraente para a reconstrução do trânsito alimentar após esofagectomia subtotal.

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“…These patients were either treated with endoscopic dilatation or by trans-oral Foley's catheter self dilatation (described by our center) [13] or by a combination of both methods. Orringer reported a stricture rate of about 20 % in their experience and advocates a liberal policy of dilatation in the post-operative period [14].…”

Section: Discussionmentioning

confidence: 99%

Esophagectomy for Cancer of the Esophagus. A Regional Cancer Centre Experience

Vijayakumar

Burrah

Hari

et al. 2013

Indian J Surg Oncol

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Surgery is an important component of treatment for patients with resectable cancer of the mid and lower third of the esophagus. There are many controversies associated with esophagectomy. We share our experience with esophagectomy for cancer of the mid and lower third of the esophagus. Between January 2007 and December 2011, 210 patients with cancer of the esophagus underwent surgery. The patients' pre and intra-operative factors, morbidities and mortality were noted and studied. Transhiatal esophagectomy was done in 175 patients and right transthoracic esophagectomy was done in 35 patients. The most common location of the tumor was lower third and most common histopathology was squamous cell carcinoma. There were 5 in-hospital deaths (2.4 %) and the common morbidities encountered were respiratory (30 %), anastomotic leak (5 %) and anastomotic stricture (15 %). The morbidity was higher in the transthoracic group. Our R0 resection rate was 89 %. Esophagectomy can be accomplished with acceptable morbidity in the management of patients with oesophageal cancer. We attribute the favourable results to the high volume at our centre, surgical expertise, good patient selection and performance of the anastomosis in the neck.

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Two Thousand Transhiatal Esophagectomies

Cited by 449 publications

References 26 publications

Non-conventional surgical approach to achalasia: mucosectomy and endomuscular pull-through

Non-conventional surgical approach to achalasia: mucosectomy and endomuscular pull-through

Cervical esophagogastric anastomosis with invagination after esophagectomy

Esophagectomy for Cancer of the Esophagus. A Regional Cancer Centre Experience

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