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Transhiatal esophagectomy for benign disease
The Journal of Thoracic and Cardiovascular Surgery
|November 1, 1985
Summary
Transhiatal esophagectomy is a safe and effective surgical option for benign esophageal diseases, even in patients with prior operations. Stomach reconstruction offers superior long-term functional outcomes compared to colon.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Thoracic Surgery
Background:
- Benign esophageal diseases, including strictures and neuromotor dysfunction, often necessitate surgical intervention.
- Many patients requiring esophagectomy have a history of multiple previous esophageal operations, complicating treatment.
- Transhiatal esophagectomy offers a less invasive approach compared to traditional thoracotomy.
Purpose of the Study:
- To evaluate the safety and efficacy of transhiatal esophagectomy without thoracotomy in adult patients with benign esophageal disease.
- To compare the functional outcomes of gastric versus colonic interposition for esophageal replacement.
- To assess the feasibility of this technique in patients with a history of prior esophageal surgeries.
Main Methods:
- A retrospective review of 65 adult patients who underwent transhiatal esophagectomy for benign esophageal conditions.
- Esophageal replacement was performed using gastric (82%) or colonic (18%) conduits.
- Patient outcomes, including intraoperative and postoperative complications, mortality, and long-term functional results, were analyzed.
Main Results:
- The procedure was performed in patients with strictures, neuromotor dysfunction, perforation, caustic injury, and reflux.
- Nearly 70% of patients had undergone at least one prior esophageal operation.
- The overall hospital mortality rate was 8%, with no deaths directly related to the esophagectomy technique. Excellent functional results were observed in 42 of 46 patients with cervical esophagogastric anastomosis, though some required dilation.
Conclusions:
- Transhiatal esophagectomy is a feasible and safe surgical approach for benign esophageal disease, even in patients with extensive prior surgical history.
- Gastric substitution is associated with superior long-term functional results and a technically simpler initial operation compared to colonic substitution.
- The technique demonstrates a low complication rate and acceptable mortality, making it a viable option for complex esophageal reconstruction.