ESOPHAGEAL RESECTION

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ESOPHAGEAL RESECTION

• DR V JONKER
• Dept cardiothoracic Surgery
• Yunivesithi Ya Freistata

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PREOP EVALUATION

• Physiologic evaluation
• Radiological evaluation contrast, endoscopy,
  CT, bronchoscopy
• EUS
• Thoracoscopy, Laparoscopy
• Lung functions
• Cardiac echo/ stress test

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TYPES OF RESECTION

• IVOR LEWIS ESOPHAGECTOMY

• INDICATIONS
• High grade dysplasia
• Carcinoma
• Caustic injury
• Not for upper 1/3 ca
• Laparotomy
• Thoracotomy
• McKeown Modification - Cervical incision

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• (L) TRANSTHORACIC APPROACH
• RADICAL EN-BLOCK RESECTION

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• THREE-FIELD NODAL DISSECTION

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• Postoperative course
• Ventilation
• Diuresis
• Mobilization
• NG tube removal/ Jejunostomy feeding
• Postop Barium Swallow- day 6
• Remove J-tube 4 weeks postop

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• COMPLICATION MANAGEMENT
• Anastomosis leak
• Anastomotic stricture
• Delayed gastric emptying
• Reflux

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• ORRINGER TRANSHIATAL ESPOHAGECTOMY
• Orringer vs Ivor Lewis
• 3 Phases
• Abdominal
• Mediastinal
• Cervical

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• COLONIC INTERPOSITION
• Indications
• (L) Colon preferable
• Colon vs Stomach
• Complications

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• JEJUNUM INTERPOSITION
• Indications
• Children
• FREE INTESTINL TRANSFER
• MINIMALLY INVASIVE ESOPHAGECTOMY