Esophagectomy and laparoscopic gastric mobilization with minilaparotomy for tubulization and esophageal replacement

Several alternatives for esophageal resection and replacement with laparoscopic, thoracoscopic, video-assisted, or completely endoscopic techniques have been reported. All of these have advantages and disadvantages according to the indications, instrumental requirements, cost, and feasibility. Here we report a new alternative procedure, performing the gastric mobilization and transhiatal esophageal dissection by laparoscopic approach and preparation of the gastric tube through a midline 5-cm minilaparotomy. In this manner we handled the GIA staplers outside of the abdomen, avoiding prolongation of the operating time and the excessive increase of the cost of the procedure. Further, this procedure may help to prevent the risk of postoperative leak of the stapler suture line by reinforcing this suture with a invaginating continuous manual 3-0 reabsorbable suture (Monocryl, Johnson & Johnson, Cincinnati, OH, U.S.A.). A left anterolateral cervicotomy was done to complete the dissection of the esophagus, and the gastric tube was ascended through a retrosternal tunnel to the neck for esophagogastroanastomosis. We operated on a 73-year-old woman, who had a T1 squamous carcinoma of middle third of the esophagus. The operation was performed with no intraoperative complications as a result of the procedure. After surgery, pneumonia with a pleural effusion developed and was evacuated. The patient was discharged from the hospital with no symptoms. We believe that this is a safe, inexpensive, and easy procedure for the transhiatal laparoscopic esophagectomy and its replacement by a gastric tube.