General Surgery · Upper GI

Transhiatal Oesophagectomy

OPERATION: Transhiatal Oesophagectomy with Cervical Anastomosis
ANAESTHETIC: General anaesthesia — single-lumen endotracheal tube (no thoracotomy). Thoracic epidural optional.
ANTIBIOTICS: IV antibiotics at induction. VTE prophylaxis from induction.
POSITION: Supine. Small transverse roll under shoulder blades. Head turned to the right. Abdomen, both anterior chest walls, and left neck prepared.

INDICATION:
Carcinoma of the lower or distal oesophagus / GOJ — suitable for transhiatal approach without thoracotomy. [Particularly suitable for: patients with poor pulmonary reserve (FEV1 <40% predicted) / lower oesophageal/GOJ tumours / end-stage benign disease / cervical exenteration reconstruction]. Preoperative staging: EUS, CT staging, OGD. [Neoadjuvant chemoradiotherapy completed]. J-tube planned.

ABDOMINAL PHASE:
Upper midline laparotomy. Abdominal exploration — metastatic disease excluded. Gastric mobilisation and conduit creation performed as for McKeown procedure: short gastric vessels divided; left gastric artery pedicle divided at origin after nodal clearance; greater curvature dissected to pylorus; full Kocher manoeuvre. Pyloroplasty or pyloromyotomy performed.