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Digestive Diseases

Minimally invasive transhiatal esophagectomy provides a treatment option for patients with esophageal cancer and other esophageal disorders

10/01/2007

Transhiatal esophagectomy provides an additional treatment option for patients with esophageal cancer, premalignant conditions of the esophagus such as Barrett’s esophagus with high-grade dysplasia and end-stage achalasia, as well as other selected benign conditions of the esophagus. Along with other treatments, including ablative therapies and endoscopic mucosal resection, transhiatal esophagectomy provides a less invasive alternative to traditional open esophageal surgery. Laparoscopic transhiatal esophagectomy is a minimally invasive surgery performed through several small incisions that are each about 1 cm in size. Using a video camera and laparoscopic instruments, the esophagus is removed and replaced with the stomach. This new technique avoids the large abdominal and chest incisions that were once an essential part of esophageal resection.

Treatable conditions

Laparoscopic transhiatal esophagectomy can be appropriate for treating the following conditions:

  • Cancer of the esophagus
  • Barrett’s esophagus (intestinal metaplasia) with high-grade dysplasia
  • Persistent esophageal strictures
  • End-stage achalasia

How it works

The surgery is performed under a general anesthetic. A camera is placed into the abdomen through a 1 cm incision. Four additional 1 cm incisions are made, through which laparoscopic instruments are placed. An additional 3-4 cm incision is sometimes required, depending on the patient’s size. As in a conventional esophagectomy, the esophagus is removed, along with inflamed or diseased tissue. The stomach is fashioned into a tube and brought up through the chest into the neck where it is attached to a small section of esophagus that is left in place.

Advantages of laparoscopic transhiatal esophagectomy

Laparoscopic transhiatal esophagectomy can offer several advantages over conventional open surgery, including: 

  • smaller incisions
  • shorter operating time
  • less trauma to the body
  • shorter hospital stay
  • quicker recovery
  • return to diet in approximately three days
  • fewer complications, including pneumonia, heart attack, stroke or anastomotic leak
  • less post-operative pain
  • earlier return to work

Other surgical options

UCLA offers a full range of interventions for esophageal disorders, enabling surgeons to provide the most appropriate care for each individual patient. Trans-thoracic minimally invasive esophagectomy involves incisions in the chest and abdomen and is preferred for patients with high- and mid-esophageal tumors, tumors that are very close to the airway, or insufficient stomach tissue to pull up to the neck. In other instances, an en-bloc esophagectomy may be indicated. This procedure involves incisions in the neck, chest and abdomen to remove the esophagus, the tumor and lymph nodes in all three areas.

UCLA Center for Esophageal Disorders

It is well established that surgeons highly experienced in performing a procedure often achieve the best outcomes. Laparoscopic transhiatal esophagectomy is a complex surgery, but one that can produce excellent results in the hands of a skilled surgeon accomplished in operating on the foregut. The UCLA Center for Esophageal Disorders offers comprehensive care for disorders of the esophagus. The skilled care team includes surgeons, gastroenterologists, pathologists, radiologists, oncologists, radiation oncologists, nurses and technicians who specialize in the diagnosis and treatment of benign and malignant esophageal disorders including GERD (gastroesophageal reflux disease), achalasia, esophageal diverticulas (including Zenker’s diverticulum), hiatal hernia, Barrett’s esophagus, esophageal cancer and other esophageal motor disorders. The Center offers the full range of treatment options, from conservative approaches to highly aggressive therapies, for all types of esophageal disorders. A dedicated operating room and anesthesia team, innovative surgical procedures, state-of-the-art equipment and techniques, patient support services and the latest medical treatments and clinical trials are all available at the Center.

Patient referral

For referrals or more information about laparoscopic transhiatal esophagectomy, please call the UCLA Center for Esophageal Disorders at (310) 825-6167.

Program physicians

Jay M. Lee, M.D.
Surgical Director, UCLA Center for Esophageal Disorders

Bennett Roth, M.D.
Clinical Professor
Division of Digestive Diseases/Gastroenterology
Medical Director, UCLA Center for Esophageal Disorders

James Farrell, M.D.
Assistant Professor
Division of Digestive Diseases/Gastroenterology

Wilfred Weinstein, M.D.
Professor
Division of Digestive Diseases/Gastroenterology

Zev Wainberg, M.D.
Clinical Instructor
Division of Hematology and Oncology

Steve Lee, M.D.
Associate Professor
Department of Radiation Oncology

David Dawson, M.D.
Assistant Professor
Department of Pathology and Laboratory Medicine

Sarah Dry, M.D.
Assistant Professor
Department of Pathology and Laboratory Medicine





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