ESOPHAGEAL RESECTION DR V JONKER Dept cardiothoracic Surgery Yunivesithi Ya Freistata

PREOP EVALUATION  Physiologic evaluation  Radiological evaluation – contrast, endoscopy, CT, bronchoscopy  EUS  Thoracoscopy, Laparoscopy  Lung functions  Cardiac echo/ stress test

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

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

 THREE-FIELD NODAL DISSECTION

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

 COMPLICATION MANAGEMENT –Anastomosis leak –Anastomotic stricture –Delayed gastric emptying –Reflux

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

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

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