Skip to Main Content

++

  • Resectable esophageal carcinoma.
  • Barrett esophagus with high-grade dysplasia.
  • Carcinoma of the cardia or proximal stomach.
  • Achalasia.
  • Advanced disease (mega-esophagus).
  • Failed esophagomyotomy.
  • Benign (undilatable) stricture.
  • Recurrent hiatal hernia or reflux esophagitis following multiple hiatal hernia repairs.

++

Absolute

++

  • Biopsy-proven distant metastatic (stage IV) esophageal cancer.
  • Tracheobronchial invasion by upper or mid-third tumors visualized on bronchoscopy.
  • Aortic invasion demonstrated on MRI, CT scan, or endoscopic ultrasound (EUS).

++

Relative

++

  • Cardiopulmonary comorbidities.
  • Previous esophageal surgery causing excessive mediastinal adhesions.
  • Previous radiation therapy (more than 6–12 months prior) causing mediastinal and esophageal radiation fibrosis.

++

  • After induction of general anesthesia, flexible endoscopy is performed by the operating surgeon to verify the exact location of the mass or abnormality and to ensure that there is an adequate normal length of proximal esophagus above for construction of a cervical esophagogastric anastomosis.
  • Following completion of endoscopy, a 16 French nasogastric tube is placed to evacuate air from the stomach.
  • The patient should be supine with a folded blanket under the shoulders to provide adequate neck extension.
    • The head is turned to the right and supported on a padded head ring.
    • The skin of the neck, chest, and abdomen is prepared and draped from the angle of the mandible superiorly to the pubis inferiorly, and from both midaxillary lines anteriorly.
    • Both arms are padded and tucked at the patient's side following the placement of arterial and venous access lines.

++

  • Immediate postoperative chest radiograph while the patient is in the operating room to exclude unrecognized pneumothorax or hemothorax.
  • Extubation in the operating room and initiation of epidural anesthesia.
  • Early use of an incentive spirometer within several hours of awakening from anesthesia.
  • Early ambulation beginning on postoperative day (POD) 1.
  • Ice chips by mouth (not to exceed 30 mL/h) for throat comfort until the nasogastric tube is removed on POD 3.
  • Initiation of oral liquids on POD 4, with progressive daily advancement to full liquids, then mechanical soft (pureed) diet, and a soft diet by POD 7.
  • Initiation of jejunostomy tube feedings on POD 3 and tapering as oral intake increases.
  • Monitoring for resolution of ileus.
  • Barium swallow examination on POD 7 to document integrity of the anastomosis, adequate gastric emptying through pylorus and hiatus, and absence of obstruction at the jejunostomy site.
  • If oral intake is poor, nocturnal jejunostomy tube feeding supplementation can be used.
  • If the patient is eating well and has no complications, the jejunostomy tube can be removed 4 weeks postoperatively during follow-up examination.

++

Intraoperative

++

  • Pneumothorax.
  • Hemothorax.
  • Uncontrollable mediastinal bleeding (< 1%).
  • Need for thoracostomy tubes due to entry into pleural cavity (75%).
  • Iatrogenic splenectomy (3%).
  • Membranous tracheal laceration (< 1%).
  • Injury to the gastric or duodenal mucosa during pyloromyotomy (< 2%).

++

Early Postoperative

++

  • Recurrent laryngeal nerve injury (< 1–2%) causing hoarseness and difficulty swallowing.
  • Chylothorax (1%).
  • Cardiac arrhythmia (atrial fibrillation).
  • Sympathetic pleural effusion.
  • Pneumonia and atelectasis (2%).
  • Cervical esophagogastric anastomotic ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessAnesthesiology Full Site: One-Year Subscription

Connect to the full suite of AccessAnesthesiology content and resources including procedural videos, interactive self-assessment, real-life cases, 20+ textbooks, and more

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessAnesthesiology

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.