Transhiatal Esophagectomy

Jules Lin, Mark B. Orringer

Key Points

  • A successful transhiatal esophagectomy involves an orderly series of steps: the abdominal, cervical, mediastinal, and cervical esophagogastric anastomotic phases of the operation.
  • A surgeon’s assessment of esophageal mobility on manual palpation through the diaphragmatic hiatus is the most important determinant of the appropriateness of a transhiatal esophagectomy.
  • A surgeon performing a transhiatal esophagectomy is not absolved of the responsibility of having a firm knowledge of thoracic anatomy and the complications of esophagectomy and their management.
  • A properly mobilized stomach should be as pink in the neck prior to the esophagogastric anastomosis as it was in the abdomen when the operation began.
  • A cervical esophagogastric anastomotic leak translates to a stricture in 50% of cases; a meticulous side-to-side stapled anastomosis minimizes the risk of this complication and the need for life long dilations.

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