0
ARTICLE |

Transdiaphragmatic Approach to the Posterior Mediastinum and Thoracic Esophagus

Richard C. Thirlby, MD; Stefan J. M. Kraemer, MD; Lucius D. Hill, MD
Arch Surg. 1993;128(8):897-902. doi:10.1001/archsurg.1993.01420200071012.
Text Size: A A A
Published online

Objective:  Complex operations involving the lower esophagus and posterior mediastinum are frequently compromised by poor exposure, thereby requiring combined thoracic and abdominal incisions. We describe our technique and report our experience with a transdiaphragmatic approach to the posterior mediastinum that improves exposure and eliminates the need for thoracotomies.

Patients:  The lower thoracic esophagus and posterior mediastinum were exposed through a semicircular incision in the central tendon of the diaphragm. The indications for operation in 14 patients were benign conditions of the lower esophagus (reflux esophagitis, lye stricture, scleroderma, and achalasia) (n=8), malignant neoplasm of the lower esophagus (n=3), and revagotomy (n=3).

Results:  All indicated procedures, resections, and esophagogastric, esophagojejunal, or esophagocolonic anastomoses were completed through abdominal and/or cervical incisions. There were no thoracotomies performed.

Conclusions:  We believe this transdiaphragmatic approach greatly improves exposure to the lower and middle esophagus and posterior mediastinum compared with transhiatal approaches; preserves the integrity of the gastroesophageal junction; allows easy access to the vagus nerves without risking esophageal injury in patients who had undergone surgery previously; shortens operative time; and lessens pulmonary morbidity and decreases patients' pain and recovery time when compared with thoracotomy.(Arch Surg. 1993;128:897-902)

Topics

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

Figures

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Jobs
brightcove.createExperiences();