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Index 161
operative strategy in, 115–116
operative technique in, 116–125
pitfalls and danger points in, 115
postoperative care following, 126
preoperative preparation for, 115
Gastrosplenic ligament, in
transabdominal Nissen
fundoplication, 85–86
Gastrostomy, Stamm, 154
in jejunum interposition, 82
Gerota’s fascia, 20–21
Graspers, closed, 98, 99
H
H
-blockers, 5
2
Hemigastrectomy, in bile diverting
procedures, 128
Hemodynamic monitoring, in
transhiatal esophagectomy
patients, 67
Hemorrhage
esophagogastrectomy-related, 34
posterior gastropexy-related, 111
transhiatal esophagectomy-related,
66, 67
transthoracic gastroplasty-related,
115
prevention of, 115–116
Hepatic arteries
left
division of, 85
posterior gastropexy-related
injury to, 107
left accessory
in esophagogastrectomy, 42, 45
in transthoracic gastroplasty,
118, 120
replaced, 100
Hepatic vein, Nissen fundoplication-
related injury to, 85
Hernia
diaphragmatic, esophagomyotomy-
related, 143
hiatal, 4–5
incarcerated, 5
paraesophageal, 4, 5, 7
posttraumatic, 4–5
repair of, 85
sliding, 4, 5–6
Hill repair. See Gastropexy, posterior
(Hill repair)
Hydropneumothorax, esophageal
perforation-related, 9
Hypaque swallow, 106
Hypotension, transhiatal
esophagectomy-related, 66
I
Instruments, as esophageal
perforation cause, 9
Intercostal muscle flap repair, of
esophageal perforations, 151,
152, 153
Intercostal muscles, division of
in esophagogastrectomy with left
thoracoabdominal approach,
38, 39
in transthoracic gastroplasty, 116
Intercostal nerves, in
esophagogastrectomy with
left thoracoabdominal
approach, 50, 51
Intestinal obstruction, bile diversion
operations-related, 132
J
Jejunogastrostomy, in jejunum
interposition, 82, 83
Jejunojejunostomy, in jejunum
interposition, 82
Jejunum interposition, 81–83
with Collis-Nissen gastroplasty, 81
disadvantages of, 3–4
esophagojejunostomy in, 82
incision in, 81
jejunogastrostomy in, 82, 83
jejunojejunostomy in, 82
mobilization of jejunum graft in, 82
pyloromyotomy in, 83
pyloroplasty in, 83
resection of diseased esophagus
in, 81–82
Stamm gastrostomy in, 82
K
Kocher maneuver
in duodenojejunostomy Roux-en-Y
switch operation, 131
in esophagectomy, 20–21, 22
in esophagogastrectomy with left
thoracoabdominal approach,
45, 46
in transhiatal esophagectomy, 67
Kyphoscoliosis, paraesophageal hiatal
hernia-related, 4
L
Laparoscopy, for hiatal hernia-related
gastroesophageal reflux
treatment, 5–6
Latissimus dorsi muscle, division of
in esophagogastrectomy, 37–38
in transthoracic gastroplasty, 116
M
Manometry, esophageal
for esophagocardiac junction
pressure measurement, 108
for gastroesophageal reflux
evaluation, 5
prior to transabdominal Nissen
fundoplication, 85
Median arcuate ligament
identification and liberation of,
107, 111–112
Hill’s method for, 107, 111
Vansant’s method for, 107, 112
suturing of, 112
Mediastinitis, esophageal perforation-
related, 150–151
Motility disorders, of the esophagus,
11. See also Achalasia
Myotomy. See also
Esophagomyotomy;
Pyloromyotomy
balloon, as achalasia treatment,
10–11
cricopharyngeal, as Zenker’s
diverticulum treatment,
134–138
closure of, 138
complications of, 138
dissection technique in, 136–137
incision and exposure in,
134–136
myotomy technique in, 137–138
operative strategy in, 134
operative technique in, 134–138
postoperative care following,
138
preoperative preparation for,
134
Heller, as achalasia treatment,
10–11
N
Neck
dissection of, in transhiatal
esophagectomy, 67
esophageal diversion in, 153–154
esophagogastric reconstruction in,
29–21
perforations of, 150
Nissen fundoplication
definition of, 6
with esophageal anastomosis, 27
end-to-side anastomosis, 55
in esophagogastrectomy with left
thoracoabdominal approach,
36, 55
laparoscopic, 95–106
complications of, 95, 106
creation of the wrap in, 95,
105–106
dissection of the hiatus in, 96,
98–100
exposure of the hiatus in, 95, 96,
97
identification of the esophagus
in, 98
162 Index
Nissen fundoplication (cont.)
indications for, 95
mobilization of the esophagus
in, 95, 100–102
operating room setup for, 95–96
operative strategy in, 95
operative technique in, 95–106
patient positioning in, 95–96
pitfalls and dangers in, 95
postoperative care following,
106
preoperative preparation for, 95
short gastric vessel division in,
95, 102, 103–105
trocar placement in, 96
transabdominal, 85–94
abdominal closure in, 93
antireflux valve testing in, 92–93
complications of, 85, 86, 93
gastric fundus mobilization in,
85
hiatal defect repair in, 91
incision in, 87
indications for, 85
length of the fundoplication, 86,
92
mobilization of the esophagus
in, 87–90
mobilization of the gastric
fundus in, 85, 87, 90, 91
operative strategy for, 85–87
operative technique for, 87–93
pitfalls and danger points in, 85
postoperative care in, 93
preoperative preparation for, 85
splenic injury prevention in,
85–86
suture line disruption in, 86
suturing of the fundoplication
in, 91–92
tightness of the fundoplication,
86, 91–92
in transthoracic gastroplasty, 122,
123, 124, 126
P
Palliative treatment, of unresectable
esophageal carcinoma, 2
Pancreatitis, hemorrhagic, 34
Pedicle flaps, in esophageal
perforation repair, 151
Penrose drains, 68–69
pH, esophageal, 5
Phrenoesophageal ligaments,
division of, 108, 109
Pledgets, Teflon, 92
Pleural flap repair, of thoracic
esophageal perforation,
150–152
Pneumothorax
esophageal perforation-related,
9
tension
laparoscopic Nissen
fundoplication-related,
95
transhiatal esophagectomy-
related, 68
Proton pump inhibitors, 5, 6
Pseudoachalasia, 11
Pulmonary complications, of
esophagectomy, 33
Pyloromyotomy
in esophagectomy, 21–23
in esophagogastrectomy with
left thoracoabdominal
approach, 45
in jejunum interposition, 83
in long segment colon
interposition, 77
in transhiatal esophagectomy, 67,
70
Pyloroplasty, in jejunum
interposition, 83
R
Recurrent laryngeal nerve
cricopharyngeal myotomy-related
palsy of, 138
in esophagogastrectomy with left
thoracoabdominal approach,
52, 53
transhiatal esophagectomy-
related injury to, 66–67
Retractors
Army-Navy, 112
esophageal, 100–102
Finochietto, 17, 23, 50, 116
Harrington, 17
liver, 96, 97
Thompson, 17, 85
Weinberg blade o, 67
Upper Hand, 85
Weinberg, 17
Roux-en-Y reconstructions
in bile diversion operations, 7,
127, 128
duodenojejunostomy switch
operation, 131–132
following esophagogastrectomy,
128–129, 130
following failed antireflux
operations, 127
with vagotomy and antrectomy,
128
as delayed gastric emptying cause,
7
esophagojejunosomy, 1
S
Scissors, Metzenbaum, 21, 38, 108
Sepsis
esophageal perforation repair-
related, 155
esophagogastrectomy-related, 36
Short gastric vessels, division of
in Nissen fundoplication, 95, 102,
103–105
in transthoracic gastroplasty, 121
Small intestine, herniation of, Nissen
fundoplication-related, 95,
102
Spasms, esophageal, diffuse,
esophagomyotomy for, 139,
143
Spleen, intraoperative injury to
laparoscopic Nissen
fundoplication-related, 95
posterior gastropexy-related, 107,
110–111
transabdominal Nissen
fundoplication-related, 85–86
transhiatal esophagectomy-related,
66
transthoracic gastroplasty-related,
115
Splenectomy, in
esophagogastrectomy with
left thoracoabdominal
approach, 40, 42
Sponge-holders, 68
Stenosis, of anastomosis, 33
Stomach
decompression of, 154–155
herniation of, laparoscopic Nissen
fundoplication-related, 95,
102
involvement in paraesophageal
hernias, 5
laparoscopic Nissen
fundoplication-related injury
to, 95
mobilization of
in esophagectomy, 17–20
in esophagogastrectomy, 42–45
in esophagogastrectomy with
left thoracoabdominal
approach, 42–45
in transthoracic gastroplasty,
115
transection of, in
esophagogastrectomy, 45–48
volvulus of, 5
Stomach cancer,
esophagogastrectomy
treatment of, 34–65
Stomach interposition, in esophageal
replacement, 3
Index 163
Strictures, esophageal
cervical leaks-related, 2
dilation of, during transthoracic
gastroplasty, 120–121
gastroesophageal reflux-related,
6–7
surgical treatment of, 6–7
with colon or jejunum
interpositions, 73–83
with esophagogastrectomy,
34–65
with transhiatal esophagectomy,
66–71
Surgical legacy techniques
esophageal anastomosis stapling
technique, 52, 54–58
posterior gastropexy (Hill repair),
107–114
T
Thoracic duct, transhiatal
esophagectomy-related injury
to, 66
Thoracotomy, right
for azygos vein trauma-related
hemorrhage control, 67
with esophagectomy, 13–33
in gastric cardia carcinoma, 1
in midthoracic esophageal
carcinoma resection, 1–2
Total parenteral nutrition, 155
Trachea, membranous, transhiatal
esophagectomy-related
laceration of, 66
V
Vagotomy
in bile diversion procedures, 127, 128
in esophageal replacement, 3, 4
inadvertent, transthoracic
gastroplasty-related, 115
Vagus nerves
anterior, 98
in esophageal perforation repair,
153, 154
in esophagogastrectomy with left
thoracoabdominal approach,
40, 41
hepatic branch of, in
transabdominal Nissen
fundoplication, 85
left
division of, 67
in esophagogastrectomy, 45
in posterior gastropexy (Hill
repair), 108
in transabdominal Nissen
fundoplication, 87, 90
right
division of, 67
in posterior gastropexy (Hill
repair), 108
in transabdominal Nissen
fundoplication, 87, 90
Vena cava
posterior gastropexy-related injury
to, 107
transabdominal Nissen
fundoplication-related injury
to, 85
Venous compression,
esophagectomy-related, 13
Volvulus, gastric, 5
Vomiting, as thoracic esophageal
perforation cause, 9
Y
Yeast, esophageal content of, 8
Z
Zenker’s (pharyngoesophageal)
diverticulum, cricopharyngeal
myotomy and operation for,
134–138
closure of, 138
complications of, 138
dissection technique in, 136–137
incision and exposure in, 134–136
myotomy technique in, 137–138
operative strategy in, 134
operative technique in, 134–138
postoperative care folowing, 138
preoperative preparation for, 134