Imran Anwar, Shah T A, Gardezi J R.
Transhiatal Esophagectomy for malignant diseases of Esophagus (An evaluation of the results).
Pak Postgrad Med J Jan ;11(1):32-5.

Esophageal carcinoma is difficult to treat but significant results are obtained by resecting the diseased esophagus and establishing gastrointestinal continuity with cervical esophagogastric anastomosis using the transhiatal route which involves nonvisual blunt dissection of the esophagus. This study of 30 patients, evaluates our results in the management of carcinoma of the middle and lower third of the esophagus. We followed the operative technique popularized by Orringer. 17 of our patients were male and 13 were female with a mean age of 51.07 years. Progressive dysphagia was the chief complaint of all our cases with a mean duration of 3.5 months. Weight loss and nutritional status were corrected preoperatively. Ultrasound, chest Radiology i.e. X-ray and CT Scan of the chest and bronchoscopy were our main diagnostic and staging tools. Cases with carcinoma of the middle (23%) and lower end (76%) of esophagus were included in the study. Incidence of squamous carcinoma, adenocarcinoma and Hodgkin`s disease was 73%, 23% & 33% respectively. Our average operative time was 2.15 hours. Major complications were pneumothorax (30%) managed by chest intubation and anastomotic leak (13.3%) managed conservatively. Other complications included postoperative stricture formation (10%), recurrent disease (3.3%) and splenectomy (7%) due to iatrogenic injury. The overall mortality was 6.6%. We lost most of our patients in follow up and this is a major problem in Pakistan, which hampers many of our studies.

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