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Surgery For Esophageal Disease

Surgery for Esophageal Disease

1. Stomach

A. Arguments to use the stomach
1) rich blood supply
2) thick wall
3) easy to mobilize
B. Position
1) posterior mediastinum
a) preferred location
2) retrosternal
a) residual disease
b) mediastinal inflammation
c) prior radiation
C. Radical En Bloc Resection
1)10 cm margins
2) excision of all adjacent tissues
3) greater omentum, spleen, retroperitoneal lymph nodes, pleura, pericardium and esophageal hiatus
4) results:
a) 11% operative mortality
b) survival:
(1) 24 % @ 3 years
(2) 18% @ 5 years

2. Colon

A. Advantages
1) peristalsis
2) clears acid
3) good caliber
4) used to handling bulk
B. Assessment /Preparation
1) angiogram
2) colonoscopy or BE if patient older than 40
3) bowel prep
C. Choices
1) may use left, right or middle
2) isoperistaltic is probably better
3) route: sub Q, retrosternal, posterior mediastinal, transpleural

3. Jejunum

A. 22mm on a single vascular pedicle
B. take 15- 30 cm from the ligament of trietz
C. transverse cervical artery is good but can use most vessels in the neck
D. contraindications:
1) age less than three
2) patient's stabiltiy
3) extensive carotid disease
E. results:
1) 85-90 % graft survival
2) 5-20 % operative mortality
3) 80-90 % with adequate swallowing