NDLI: Laparoscopic transhiatal approach for resection of an adenocarcinoma in long-segment Barrett’s esophagus

Content Provider	PubMed Central
Author	Shiozaki, Atsushi Fujiwara, Hitoshi Konishi, Hirotaka Kinoshita, Osamu Kosuga, Toshiyuki Morimura, Ryo Murayama, Yasutoshi Komatsu, Shuhei Yoshiaki, Kuriu Ikoma, Hisashi Nakanishi, Masayoshi Ichikawa, Daisuke Okamoto, Kazuma Sakakura, Chouhei Otsuji, Eigo
Copyright Year	2015
Abstract	Barrett’s esophagus (BE) is a precursor of esophageal adenocarcinoma and is associated with gastroesophageal reflux disease, which is often preceded by a hiatal hernia. We describe a case of esophageal adenocarcinoma arising in long-segment BE (LSBE) associated with a hiatal hernia that was successfully treated with a laparoscopic transhiatal approach (LTHA) without thoracotomy. The patient was a 42-year-old male who had previously undergone laryngectomy and tracheal separation to avoid repeated aspiration pneumonitis. An ulcerative lesion was found in a hiatal hernia by endoscopy and superficial esophageal cancer was also detected in the lower thoracic esophagus. The histopathological diagnosis of biopsy samples from both lesions was adenocarcinoma. There were difficulties with the thoracic approach because the patient had severe kyphosis and muscular contractures from cerebral palsy. Therefore, we performed subtotal esophagectomy by LTHA without thoracotomy. Using hand-assisted laparoscopic surgery, the esophageal hiatus was divided and carbon dioxide was introduced into the mediastinum. A hernial sac was identified on the cranial side of the right crus of the diaphragm and carefully separated from the surrounding tissues. Abruption of the thoracic esophagus was performed up to the level of the arch of the azygos vein via LTHA. A cervical incision was made in the left side of the permanent tracheal stoma, the cervical esophagus was divided, and gastric tube reconstruction was performed via a posterior mediastinal route. The operative time was 175 min, and there was 61 mL of intra-operative bleeding. A histopathological examination revealed superficial adenocarcinoma in LSBE. Our surgical procedure provided a good surgical view and can be safely applied to patients with a hiatal hernia and kyphosis.
Related Links	http://dx.doi.org/10.3748/wjg.v21.i29.8974
Starting Page	8974
File Format	PDF
ISSN	10079327
e-ISSN	22192840
Journal	World Journal of Gastroenterology : WJG
Issue Number	29
Volume Number	21
Language	English
Publisher	Baishideng Publishing Group Inc
Publisher Date	2015-01-01
Access Restriction	Open
Rights Holder	Baishideng Publishing Group Inc
Subject Keyword	Gastroenterology Research in Higher Education
Content Type	Text
Resource Type	Article
Subject	Gastroenterology

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