Technical aids in performing transhiatal esophagectomy without thoracotomy.

Transhiatal esophagectomy without thoracotomy has been utilized in 200 patients: 57 with benign disease and 143 with carcinomas at various levels of the esophagus (35 pharyngeal or cervicothoracic, 7 upper third, 47 middle third, and 54 distal third). Stomach has been used to replace the esophagus in 93% of patients undergoing single-stage esophagectomy and reconstruction, and colon has been used in 7%. Among patients with intrathoracic esophageal carcinomas, intraoperative blood loss averaged 1,000 ml, and the hospital mortality was 6%. No patient in the entire series has required a thoracotomy for control of bleeding, either during the esophagectomy or postoperatively. This report reviews the technical maneuvers that my collegues and I have found useful in performing transhiatal esophagectomy without thoracotomy.