esophageal resection dr v jonker dept cardiothoracic surgery yunivesithi ya freistata
TRANSCRIPT
ESOPHAGEAL RESECTIONESOPHAGEAL RESECTION
DR V JONKERDR V JONKER
Dept cardiothoracic SurgeryDept cardiothoracic Surgery
Yunivesithi Ya FreistataYunivesithi Ya Freistata
PREOP EVALUATIONPREOP EVALUATION
Physiologic evaluationPhysiologic evaluation Radiological evaluation – contrast, Radiological evaluation – contrast,
endoscopy, CT, bronchoscopyendoscopy, CT, bronchoscopy EUSEUS Thoracoscopy, LaparoscopyThoracoscopy, Laparoscopy Lung functionsLung functions Cardiac echo/ stress testCardiac echo/ stress test
TYPES OF RESECTIONTYPES OF RESECTION
IVOR LEWIS ESOPHAGECTOMYIVOR LEWIS ESOPHAGECTOMYINDICATIONSINDICATIONS
High grade dysplasiaHigh grade dysplasiaCarcinomaCarcinomaCaustic injuryCaustic injury
Not for upper 1/3 caNot for upper 1/3 caLaparotomyLaparotomyThoracotomyThoracotomyMcKeown Modification - ® Cervical McKeown Modification - ® Cervical incisionincision
(L) TRANSTHORACIC APPROACH(L) TRANSTHORACIC APPROACH
RADICAL EN-BLOCK RESECTIONRADICAL EN-BLOCK RESECTION
Postoperative coursePostoperative course– VentilationVentilation– DiuresisDiuresis– MobilizationMobilization– NG tube removal/ Jejunostomy feedingNG tube removal/ Jejunostomy feeding– Postop Barium Swallow- day 6Postop Barium Swallow- day 6– Remove J-tube 4 weeks postopRemove J-tube 4 weeks postop
COMPLICATION MANAGEMENTCOMPLICATION MANAGEMENT– Anastomosis leakAnastomosis leak– Anastomotic strictureAnastomotic stricture– Delayed gastric emptyingDelayed gastric emptying– RefluxReflux
ORRINGER ORRINGER TRANSHIATAL TRANSHIATAL ESPOHAGECTOMYESPOHAGECTOMYOrringer vs Ivor LewisOrringer vs Ivor Lewis3 Phases3 Phases
AbdominalAbdominalMediastinalMediastinalCervicalCervical
COLONIC COLONIC INTERPOSITIONINTERPOSITION
IndicationsIndications(L) Colon preferable(L) Colon preferableColon vs StomachColon vs StomachComplicationsComplications