Transhiatal oesophagectomy: techniques, tips and outcomes

Outcome-volume relationships and transhiatal esophagectomy: minimizing "failure to rescue"

Background

The objective of this study is to describe the system and technical factors that enabled our moderate size transhiatal esophagectomy program to achieve low mortality rates.

Methods

A retrospective chart review was conducted on 200 consecutive patients who underwent transhiatal esophagectomy at Robert Wood Johnson University Hospital. Primary outcomes included operative times, estimated blood loss, frequency and nature of complications, and lengths of stay in the hospital and the intensive care unit.

Results

In general, surgical outcomes tended to improve over the course of this study. We identified decreased operative time, intra-operative blood loss, frequency of complications, and lengths of intensive care unit and hospital stay as the program matured. Through coordinated actions of the surgical and anesthesia teams, all intraoperative injuries were responded to in an effective, emergent fashion and all but one patient was saved. This resulted in an inhospital and 30-day mortality rate of only 0.5%.

Conclusions

Our study suggests that a dual attending approach, focus on avoiding “failure to rescue”, increased volume, and a surgeon driven commitment to quality improvement may lead to low mortality rates after transhiatal esophagectomy.

Persistent air-leak after transhiatal oesophagectomy: A case report

INTRODUCTION

Transhiatal oesophagectomy is a widely accepted technique for resection of tumours of the lower oesophagus. We present a life-threatening complication associated with the placement of a corrugated neck drain during this procedure.

PRESENTATION OF CASE

Our patient underwent a transhiatal oesophagectomy for a lower oesophageal tumour. He developed persistent bilateral pneumothoraces despite chest drain insertions. Following removal of the corrugated neck drain, both lungs were successfully re-inflated.

DISCUSSION

To the authors' knowledge, this serious complication has been described only once before in the medical literature; other surgeons should be made aware of this problem.

CONCLUSION

Alternative drainage systems should be considered to help prevent this injury. Exercise caution if positioning corrugated drains in the neck.

An unusual cause of collapsed lung after transhiatal oesophagectomy: a case report

Transhiatal oesophagectomy is an established technique for resection of tumours of the lower oesophagus and oesophagogastric junction. The authors describe a previously unreported serious complication associated with placement of a corrugated neck drain during transhiatal oesophagectomy. A 63 year old man was admitted for transhiatal oesophagectomy for resection of a lower third oesophageal tumour. Post operatively he developed a left sided pneumothorax which did not improve despite numerous chest drains. The subcutaneous corrugated neck drain was removed with immediate inflation of the lung. We report an important potential complication that surgeons in several specialties should be aware of, especially in the use of corrugated neck drains following transhiatal oesophagectomy.