Transhiatal esophagectomy

Transhiatal esophagectomy
Anesthesia type	General
Airway	8-O ETT
Lines and access	Large bore PIV Arterial Line NG-tube
Monitors	Standard Arterial Line
	Primary anesthetic considerations
Preoperative
Intraoperative
Postoperative	Anastamotic leak
	Article quality
Editor rating	Unrated
User likes	0

The transhiatal approach is used with a laparotomy below the xiphisternum to mobilize the stomach and create an esophageal conduit from the greater curvature of the stomach. This conduit is brought up to the neck for a gastroesophageal anastamosis at the level of a neck incision.^[1] With advances in laparoscopic and robotic surgical techniques, the transhiatal esophagestomy has been increasing in popularity once again.

Preoperative management

Patient evaluation


System	Considerations
Neurologic
Cardiovascular
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Labs and studies

Operating room setup

8-O ETT for periemergence bronchoscopy
Arterial line
Large bore peripheral IV
NG tube to decompress stomach

Patient preparation and premedication

EKG leads on back of shoulders to facilitate neck prep

Regional and neuraxial techniques

Epidural for post-operative pain control

Intraoperative management

Monitoring and access

Standard ASA Monitors
Arterial line

Induction and airway management

Positioning

Supine with both arms tucked

Maintenance and surgical considerations

Abdominal laparoscopy:

Gastric conduit creation:

Esophageal transection:

Gastric pull-through:

Watch peak and plateau pressures for signs of pneumothorax
Compression of RA may cause sudden hypotension

Anastamosis:

Avoid excessive vasopressors to uphold integrity of anastamosis site

Emergence

Postoperative management

Disposition

Pain management

Potential complications

Vocal cord palsy
Anastamotic leak
General pulmonary failure/complications

Procedure variants

Very few series have been published comparing robotic and laparoscopic approach.
	Laparoscopic	Robotic
Unique considerations
Position	Supine	Supine; arms tucked
Surgical time	279min^[2]	267-311min
EBL	88mL^[2]	54-100mL
Postoperative disposition
Pain management		Epidural
Potential complications		Pulmonary Anastamotic leak (9-33%) Vocal cord palsy (5-30%)
Length of Stay	9.2 days^[2]	9-10 days

References

↑ Nottingham, James M.; McKeown, David G. (2021), "Transhiatal Esophagectomy", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 32644622, retrieved 2021-06-17
↑ ^2.0 ^2.1 ^2.2 Seto, Yasuyuki; Mori, Kazuhiko; Aikou, Susumu (2017-09). "Robotic surgery for esophageal cancer: Merits and demerits". Annals of Gastroenterological Surgery. 1 (3): 193–198. doi:10.1002/ags3.12028. ISSN 2475-0328. PMC 5881348. PMID 29863149. Check date values in: |date= (help)

Top contributors: Nirav Kamdar, Elmar Malek and Chris Rishel

[:1-1] Nottingham, James M.; McKeown, David G. (2021), "Transhiatal Esophagectomy", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 32644622, retrieved 2021-06-17

[:0-2] 2.0 ^2.1 ^2.2 Seto, Yasuyuki; Mori, Kazuhiko; Aikou, Susumu (2017-09). "Robotic surgery for esophageal cancer: Merits and demerits". Annals of Gastroenterological Surgery. 1 (3): 193–198. doi:10.1002/ags3.12028. ISSN 2475-0328. PMC 5881348. PMID 29863149. Check date values in: |date= (help)

[1]

[2]