Transhiatal oesophagectomy

Abstract

The feasibility of removing the oesophagus from the posterior mediastinum using an instrument similar to a vein stripper was suggested by the German anatomist Denk in 1913. In 1936, the British surgeon Grey-Turner resected the oesophagus for carcinoma through abdominal and cervical incisions. Later restoration of swallowing was achieved with an antethoracic skin tube. This, and subsequent early reports of transhiatal (or blunt) oesophagectomy in which the oesophagus was resected through abdominal and cervical incisions without the need for thoracotomy, occurred before the availability of endotracheal anaesthesia permitted safe transthoracic operations. As endotracheal anaesthesia became widely available, however, the technique was all but abandoned. It was still used at times to resect a normal thoracic oesophagus concomitantly with laryngopharyngectomy for pharyngeal or cervical oesophageal carcinoma, the stomach being used to restore continuity of the alimentary tract. In the 1970s several authors reported the use of transhiatal oesophageal resection for diseases of the intrathoracic oesophagus. Orringer and associates repopularized the technique¹, and during the past 15 years numerous reports have established that transhiatal oesophagectomy is a safe alternative to traditional transthoracic oesophageal resection². Based upon a personal experience with more than 600 patients the author believes that there is seldom an indication for opening the thorax in patients requiring oesophageal resection for either benign or malignant disease.