Chassin’s Operative Strategy in Esophageal Surgery by Thomas H. Gouge (auth.), Carol E. H. Scott-Conner MD, PhD,
By Thomas H. Gouge (auth.), Carol E. H. Scott-Conner MD, PhD, MA (eds.)
Chassin’s Operative concepts in Esophageal surgical procedure bargains the reader a succinct overview of surgical suggestions for issues of the esophagus. Spanning from well-established legacy tactics to the main up to date minimally invasive techniques for GERD, this brilliantly illustrated atlas solely offers the theoretical foundation of the operations in addition to the concepts required to lead away from universal pitfalls. Educed from Chassin’s Operative thoughts as a rule surgical procedure, this quantity comprises step by step descriptions of 13 (13) operative approaches in esophageal surgery.
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Example text
3–33). It is essential that a small portion of the lateral termination of the stapled anastomosis be included in the final linear staple line. Test the integrity of the anastomosis by inserting a sterile solution of methylene blue through the nasogastric tube into the gastric pouch. The appearance of the completed stapled anastomosis is shown in Figure 3–34. Whether a Nissen fundoplication is to be constructed following this anastomosis depends on the judgment of the surgeon and the availability of loose gastric wall.
Even if the stomach is not involved, when the tumor is situated low in the esophagus the proximal lesser curvature of the stomach should be included to remove the left gastric artery at its origin and the celiac lymph nodes. Splenectomy and removal of the lymph nodes at the splenic hilus may be required for large lesions of the proximal stomach and fundus. Any suspicious nodes along the superior border of the pancreas should also be removed. Thoracoabdominal Incision with Preservation of Phrenic Nerve Function When gastric cancer encroaches on the gastroesophageal junction, operations done by abdominal incision exclusively are contraindicated for several reasons.
Close the skin with continuous 3-0 nylon or subcuticular 4-0 PG. Consider inserting a needle-catheter feeding jejunostomy. Close the abdominal wall in the usual fashion by means of interrupted no. 1 PDS sutures. Fig. 2–32 32 Esophagectomy: Right Thoracotomy and Laparotomy Fig. 2–33 Fig. 2–34 References POSTOPERATIVE CARE Keep the nasogastric tube on low suction for 4–5 days. Permit nothing by mouth until a contrast study has demonstrated integrity of the anastomosis. Obtain an esophagram with water-soluble contrast followed by thin barium on the seventh postoperative day.