Technical aids in performing transhiatal esophagectomy without thoracotomy

Area of Science:

• Surgical Oncology
• Gastroenterology
• Thoracic Surgery

Background:

• Esophageal diseases, including benign conditions and carcinomas, necessitate surgical intervention.
• Traditional esophagectomy often involves thoracotomy, carrying significant risks.
• Minimally invasive approaches are sought to improve patient outcomes.

Purpose of the Study:

• To review the technical aspects and outcomes of transhiatal esophagectomy performed without thoracotomy.
• To evaluate the efficacy and safety of this approach in a large patient cohort.

Main Methods:

• A retrospective review of 200 patients who underwent transhiatal esophagectomy without thoracotomy.
• Analysis of patient demographics, disease types (benign vs. carcinoma), tumor location, reconstructive techniques (stomach vs. colon), intraoperative blood loss, and hospital mortality.

Main Results:

• The study included 57 patients with benign disease and 143 with esophageal carcinomas.
• Stomach was the preferred conduit for reconstruction in 93% of cases.
• For intrathoracic carcinomas, average blood loss was 1000 ml, with a 6% hospital mortality rate.
• No patient required thoracotomy for bleeding control.

Conclusions:

• Transhiatal esophagectomy without thoracotomy is a safe and effective procedure for managing various esophageal conditions.
• This technique avoids the morbidity associated with thoracotomy, particularly for bleeding control.
• The use of stomach for reconstruction is predominant and successful.