Emergency Minimally Invasive Esophagogastrectomy and Delayed Esophagocoloplasty for Caustic Ingestion: A Stepwise...

Caustic ingestion is a rare but life-threatening condition that may require emergency surgery. While open surgery remains the standard approach, minimally invasive strategies are increasingly explored. Given the rarity of these cases, a standardized and reproducible approach aimed at improving outcomes is needed. In this context, a standardized stepwise technique for emergency minimally invasive total gastrectomy and transhiatal subtotal esophagectomy with cervical esophagostomy, followed by delayed reconstruction using transverse colon interposition, is described. Indications strictly followed World Society of Emergency Surgery (WSES) guidelines (Zargar ≥3a, transmural necrosis, or perforation). Six consecutive patients underwent emergency surgery. Mean operative time was 242 minutes, with one postoperative death due to sepsis. Delayed reconstruction was performed in four patients after a median of 9.5 months, with satisfactory clinical outcomes and no anastomotic leaks. Description of key technical steps is supported by a full-length annotated surgical video. A minimally invasive transhiatal approach is feasible in selected patients and may facilitate delayed reconstruction. Standardization of technique is essential to improve reproducibility in this challenging setting.