Transhiatal oesophagectomy

  • Mark B. Orringer


The feasibility of removing the oesophagus from the posterior mediastinum using an instrument similar to a vein stripper was suggested by the German anatomist Denk in 1913. In 1936, the British surgeon Grey-Turner resected the oesophagus for carcinoma through abdominal and cervical incisions. Later restoration of swallowing was achieved with an antethoracic skin tube. This, and subsequent early reports of transhiatal (or blunt) oesophagectomy in which the oesophagus was resected through abdominal and cervical incisions without the need for thoracotomy, occurred before the availability of endotracheal anaesthesia permitted safe transthoracic operations. As endotracheal anaesthesia became widely available, however, the technique was all but abandoned. It was still used at times to resect a normal thoracic oesophagus concomitantly with laryngopharyngectomy for pharyngeal or cervical oesophageal carcinoma, the stomach being used to restore continuity of the alimentary tract. In the 1970s several authors reported the use of transhiatal oesophageal resection for diseases of the intrathoracic oesophagus. Orringer and associates repopularized the technique1, and during the past 15 years numerous reports have established that transhiatal oesophagectomy is a safe alternative to traditional transthoracic oesophageal resection2. Based upon a personal experience with more than 600 patients the author believes that there is seldom an indication for opening the thorax in patients requiring oesophageal resection for either benign or malignant disease.


Neck Wound Posterior Mediastinum Recurrent Laryngeal Nerve Injury Cervical Incision Superior Mediastinum 
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  1. 1.
    Orringer MB, Sloan H. Esophagectomy without thoracotomy. J Thorac Cardiovasc Surg 1978; 76: 643–54.PubMedGoogle Scholar
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    Orringer MB. Transhiatal esophagectomy without thoracotomy for carcinoma of the thoracic esophagus. Ann Surg 1984; 200: 282–8.PubMedCentralPubMedCrossRefGoogle Scholar
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    Orringer MB, Stirling MC. Cervical esophagogastric anastomosis for benign disease — functional results. J Thorac Cardiovasc Surg 1988; 96: 887–93.PubMedGoogle Scholar
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    Orringer MB. Partial median sternotomy: anterior approach to the upper thoracic esophagus. J Thorac Cardiovasc Surg 1984; 87: 124–9.PubMedGoogle Scholar
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    Orringer MB, Bluett M, Deeb GM. Aggressive treatment of chylothorax complicating transhiatal esophagectomy without thoracotomy. Surgery 1988; 104: 720–6.PubMedGoogle Scholar
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    Orringer MB, Marshall B, Stirling MC. Transhiatal esophagectomy for benign and malignant disease. J Thorac Cardiovasc Surg 1993; 105: 265–77.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 1994

Authors and Affiliations

  • Mark B. Orringer
    • 1
  1. 1.Section of Thoracic SurgeryUniversity of Michigan Medical CenterAnn ArborUSA

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