Transhiatal esophagectomy
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.
Procedure
- 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
Complications
- anastomotic leak at the cervical anastomosis
- anastomotic stricture
- recurrent laryngeal nerve injury
Differential diagnosis
The imaging differential diagnosis includes
