Tis the season for turkey, gravy, pie and acid reflux
University of Michigan thoracic surgeons have performed more than 1,200 transhiatal esophagectomies (THE) and esophageal replacements, the largest experience with this procedure in the United States. The operation, pioneered by UM's Mark B. Orringer, M.D., is an alternative to the more traditional methods of esophageal resection for cancer which involve opening both the chest and abdomen. In Orringer's procedure, the esophagus is removed through the diaphragmatic hiatus working through an upper abdominal incision and a cervical incision without opening the chest. Alimentary continuity is re-established by mobilizing the stomach through the posterior mediastinum in the original esophageal bed and anastomosing the gastric fundus to the cervical esophagus above the level of the clavicles. Avoidance of a thoracotomy minimizes postoperative morbidity, and the cervical esophagogastric anastomosis virtually eliminates the risk of mediastinitis from an anastomotic leak inherent with a traditional intrathoracic esophagogastric anastomosis. THE has been possible in 97% of UM's operable patients requiring esophageal resection. Restoration of the ability to swallow a soft diet comfortably is generally achieved within one week. The operative mortality for this operation is now less than 3% at the UM. Using our newly developed anastomotic technique, the cervical esophagogastric anastomotic leak rate is less than 3%. No intensive care is required postoperatively, and patients with uncomplicated courses are discharged after seven days. University of Michigan general thoracic surgeons perform 80-100 esophageal resections annually.