By Carol E.H. Scott-Conner
Real Atlas, brilliantly illustrated.
Succint overview of surgical innovations, together with minimally invasiveapproachesfor GERD.
Step via Step descriptions of thirteen operative strategies in esophageal surgery.
Significantly less costly than it truly is competitors.
Educed from Chassin's Operative options in most cases surgical procedure, guaranteed to be a vintage.
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Additional info for Chassin’s Operative Strategy in Esophageal Surgery
After thoroughly irrigating the thoracic and abdominal cavities with an antibiotic solution, approximate the ribs with four or ﬁve interrupted pericostal sutures of no. 1 PDS and approximate the serratus and pectoral muscles in layers by means of continuous 2-0 atraumatic PG (Figs. 2–33, 2–34). Close the skin with continuous 3-0 nylon or subcuticular 4-0 PG. Consider inserting a needle-catheter feeding jejunostomy. Close the abdominal wall in the usual fashion by means of interrupted no. 1 PDS sutures.
Any suspicious nodes along the superior border of the pancreas should also be removed. Thoracoabdominal Incision with Preservation of Phrenic Nerve Function When gastric cancer encroaches on the gastroesophageal junction, operations done by abdominal incision exclusively are contraindicated for several reasons. In the ﬁrst place, this anastomosis frequently requires the surgeon’s hand and the needle-holder to be in an awkward position and may result in leakage. We have seen some upper gastric lesions that extended into the esophagus as far as 10 cm.
Tracheal suction is used with caution to avoid possible trauma to the anastomosis. Ventilatory support is employed when necessary. Continue prophylactic antibiotics until removal of the chest tube. Use the needle-catheter jejunostomy for enteral alimentation beginning promptly after surgery. COMPLICATIONS Anastomotic leaks. Anastomotic leaks constitute by far the most important complication of this operation, but they are preventable if proper surgical technique is used. Although minor contained leaks may be treated nonoperatively, most leaks require operative drainage, diversion, repair, or a combination of these maneuvers (see Chapter 14).