[A technic of transhiatal esophagectomy]

Esophagectomy can be carried out without thoracotomy by referring the anastomosis to the neck. This allows for complete excision of the thoracic esophagus, while avoiding the inconveniences connected with resections via mixed abdominal and thoracic routes. The stomach is the most commonly used transplant, but only a liberal resection of the small curvature enables the surgeon to reach unmistakably the hyoid bone. This technique was used in 82 patients who were operated on between January 1982 and January 1988. The lesion was benign in 10 of them and malignant in 72 (12 Killian's operations, 9 upper thirds, 30 medium thirds, and 19 lower thirds). Gastric grafts were utilized in 69 patients and colic grafts in 13 others. There were 8 deaths: 3 pulmonary infections, 2 myocardial infarctions, 1 subphrenic abscess, 1 peritonitis, and 1 case of partial necrosis of the gastric graft. Actually, this mortality rate was mainly due to the patients' background (2.8% below 75 years of age and 43% above) and not to the technique. Eleven patients developed non lethal complications (13%) such as pulmonary infections (5), subphrenic abscesses (3), cervical fistulas (2), evisceration (1), while 63 patients (77%) had an uncomplicated course with oral realimentation starting from the 7th day and hospital stay under 3 weeks. Transhiatal esophagectomy is a safe intervention which is well tolerated as far as benign esophageal lesions are concerned, as well as those interesting the upper and lower thirds of the thoracic esophagus.(ABSTRACT TRUNCATED AT 250 WORDS)