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Chassin’s Operative Strategy in Esophageal Surgery
Carol E.H. Scott-Conner, MD, PhD, MA
Professor of Surgery, Department of Surgery University of Iowa Hospitals and Clinics Iowa City, Iowa
Chassin’s Operative Strategy in Esophageal Surgery
Illustrations by Caspar Henselmann
With 210 Illustrations
Carol E.H. Scott-Conner, MD, PhD, MA Professor of Surgery Department of Surgery University of Iowa Hospitals and Clinics Iowa City, IA 52242 USA
Library of Congress Control Number: 2005926336
ISBN 10: 0-387-25941-4 ISBN 13: 987-0387-25941-3
Printed on acid-free paper.
© 2006 Springer ScienceBusiness Media, Inc.
Reprinted from Scott-Conner, Chassin’s Operative Strategy in General Surgery: An Expositive Atlas, third edition, copyright 2002, 1994, 1984 (vol. 2), 1980 (vol. 1) Springer ScienceBusiness Media.
All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer ScienceBusiness Media, Inc., 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not iden­tified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omis­sions that may be made. The publisher makes no warranty, express or implied, with respect to the material con­tained herein.
Printed in the United States of America. (BS/MVY)
987654321
springeronline.com
To Harry
Carol E.H. Scott-Conner
To Charlotte
Jameson L. Chassin
The first volume of Chassin’s Operative Surgery in General Surgery was published in 1980. That volume included three unusually rich and detailed chapters on esophageal surgery. As a senior resident in surgery, I immediately bought a copy that I used as a reference for several years. Many years passed before the second volume of that first edition was published. In due time, second and third editions followed. The ample coverage of esophageal surgery was maintained and, in fact, expanded. The esophageal section of the third edition had grown to thirteen chapters and included minimal access surgical approaches.
Times, however, change, and in the 25 years since publication of that first volume, esophageal surgery has become a specialty in itself—one shared by general surgeons, surgical oncologists and thoracic surgeons. This volume, a reprint of the Esophageal Section of the third edition, is offered as a service to those surgeons and surgeons in training who are more narrowly focused than the general surgeons of Dr. Jameson Chassin’s day. I hope that you find it valuable and useful.
Carol E.H. Scott-Conner, MD, PhD, MA

Preface

ix

Contents

Preface ix
1
Concepts in Esophageal Surgery 1
Thomas H. Gouge
Carcinoma of the Cardia Region 1 Carcinoma of the Middle and Upper
Esophagus 1 Unresectable Carcinoma 2 Carcinoma of the Esophagus: Transhiatal or
Transthoracic Approach 2 Replacing or Bypassing the Esophagus: Stomach,
Colon, or Jejunum 3 Hiatus Hernia and Reflux Disease 4 Pharyngoesophageal Diverticulum 7 Perforations and Anastomotic Leaks 8 Esophageal Perforation at Various Anatomic
Levels 9 Anastomotic Leaks 9 Achalasia 10 Other Motility Disorders 11 References 11
2
Complications 64 References 64
4
Transhiatal Esophagectomy 66
Indications 66 Preoperative Preparation 66 Pitfalls and Danger Points 66 Operative Strategy 66 Operative Technique 67 Postoperative Care 71 Complications 71 References 72
5
Operations to Replace or Bypass the
Esophagus: Colon or Jejunum Interposition 73
Indications 73 Preoperative Preparation 73 Operative Strategy 73 Operative Technique 73 References 83
Esophagectomy: Right Thoracotomy and
Laparotomy 13
Indications 13 Preoperative Preparation 13 Pitfalls and Danger Points 13 Operative Strategy 13 Operative Technique 13 Postoperative Care 33 Complications 33 References 33
3
Esophagogastrectomy: Left Thoracoabdominal
Approach 34
Indications 34 Preoperative Preparation 34 Pitfalls and Danger Points 34 Operative Strategy 34 Operative Technique 36 Postoperative Care 64
6
Transabdominal Nissen Fundoplication 85
Indications 85 Preoperative Preparation 85 Pitfalls and Danger Points 85 Operative Strategy 85 Operative Technique 87 Postoperative Care 93 Complications 93 References 93
7
Laparoscopic Nissen Fundoplication 95
Indications 95 Preoperative Preparation 95 Pitfalls and Danger Points 95 Operative Strategy 95 Operative Technique 95 Postoperative Care 106
xi
xii Contents
Complications 106 References 106
8
Posterior Gastropexy (Hill Repair): Surgical
Legacy Technique 107
Indications 107 Preoperative Preparation 107 Pitfalls and Danger Points 107 Operative Strategy 107 Operative Technique 108 Postoperative Care 114 Complications 114 References 114
9
Transthoracic Gastroplasty (Collis) and Nissen
Fundoplication 115
Indications 115 Preoperative Preparation 115 Pitfalls and Danger Points 115 Operative Strategy 115 Operative Technique 116 Postoperative Care 126 Complications 126 References 126
10
Operative Strategy 134 Operative Technique 134 Postoperative Care 138 Complications 138 References 138
12
Esophagomyotomy for Achalasia and Diffuse
Esophageal Spasm 139
Indications 139 Preoperative Preparation 139 Pitfalls and Danger Points 139 Operative Strategy 139 Operative Technique 140 Postoperative Care 143 Complications 143 References 143
13
Laparoscopic Esophagomyotomy 144
Indications 144 Preoperative Preparation 144 Pitfalls and Danger Points 144 Operative Strategy 144 Complications 149 References 149
Bile Diverting Operations for Management of
Esophageal Disease 127
Indications 127 Preoperative Preparation 127 Pitfalls and Danger Points 127 Operative Strategy 127 Operative Technique 128 Complications 132 References 132
11
Cricopharyngeal Myotomy and Operation for
Pharyngoesophageal (Zenker’s) Diverticulum 134
Indications 134 Preoperative Preparation 134
14
Operations for Esophageal Perforation and
Anastomotic Leaks 150
Indications 150 Preoperative Preparation 150 Pitfalls and Danger Points 150 Operative Strategy 150 Operative Technique 150 Postoperative Care 155 Complications 155 References 156
Index 157