Transient diminished airway protection after transhiatal esophagectomy

Fifteen consecutive patients undergoing transhiatal esophagectomy for esophageal carcinoma were studied cineradiographically to evaluate postoperative pharyngeal function. Cinepharyngo-esophagograms were obtained preoperatively and 1 week (range: 6 to 10 days) and 1 month (range: 18 to 52 days) postoperatively. One week after transhiatal esophagectomy, new radiographic swallowing abnormalities were identified in 10 patients (67%). The most common abnormalities observed were laryngeal penetration or aspiration (seven patients, 47%) and incomplete laryngeal elevation (five patients, 33%). Abnormal epiglottic tilt was seen in only two patients (13%). No postoperative pharyngeal retention and no cricopharyngeal obstruction to swallowed contrast was observed. One month after transhiatal esophagectomy, all radiographic swallowing abnormalities had resolved or improved. Laryngeal penetration or aspiration is common after transhiatal esophagectomy and is a consequence of diminished airway protection with incomplete laryngeal elevation rather than a result of esophageal obstruction with "spill-over" aspiration. These changes resolve or improve within the first postoperative month.