Cervical Esophagostomy

Published on 27/02/2015 by admin

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Last modified 27/02/2015

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CHAPTER 6 Cervical Esophagostomy

Richard Ricketts

Step 1: Surgical Anatomy

♦ The approach is usually through the left side.
♦ Note the relationship of the trachea, esophagus, recurrent laryngeal nerve, and the thoracic duct (Fig. 6-1).
image

Figure 6-1

Step 2: Preoperative Considerations

♦ Use the left side of the neck for future esophageal replacement because this procedure will be done through the left chest, the mediastinum, or in the substernal position.
♦ Use the right side of the neck for the Kimura esophageal lengthening procedure (Kimura and Soper, 1994).
♦ Preoperative prophylactic antibiotics should be given.

Step 3: Operative Steps

Anesthetic Induction

♦ Endotracheal intubation and relaxation are used.
♦ The anesthesiologist should pass a blunt tipped bougie down the esophagus; this will aid in identifying the esophagus.

Positioning

♦ Place the patient supine with a roll under the shoulders to extend the neck.
♦ Turn the head slightly to the contralateral (usually right) side.

Incision

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