Open Esophageal Procedures

2014 ◽  
Author(s):  
Cameron D Wright
Keyword(s):  
Preoperative Evaluation ◽  
Transhiatal Esophagectomy ◽  
Outcome Evaluation ◽  
Hiatal Hernia Repair ◽  
Operative Techniques ◽  
Esophageal Diseases ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
Zenker Diverticulum ◽  
Operative Planning

The growing stature of minimally invasive approaches to esophageal diseases does not diminish the importance of the equivalent open approaches. This chapter describes common open operations performed to excise Zenker diverticulum, to manage complex gastroesophageal reflux disease, and to resect esophageal and proximal gastric tumors. For each of these open procedures, the preoperative evaluation, operative planning, steps of the operative techniques, postoperative care, complications, and outcome evaluation are described. Over two dozen figures show many of the operative steps for a cricopharyngeal myotomy and excision of Zenker diverticulum, a transthoracic hiatal hernia repair, a transhiatal esophagectomy, Ivor-Lewis esophagectomy, and a left thoracoabdominal esophagogastrectomy. This chapter contains 27 figures, 12 tables, 13 references, 5 Board-styled MCQs, and 1 Teaching Slide Set.

Open Procedures for Renovascular Disease

2012 ◽  
Author(s):  
Christopher J. Godshall ◽  
Racheed J. Ghanami ◽  
Kimberley J Hansen
Keyword(s):  
Renal Function ◽  
Renal Artery ◽  
Operative Technique ◽  
Preoperative Evaluation ◽  
Outcome Evaluation ◽  
Renovascular Disease ◽  
Free Survival ◽  
Operative Planning ◽  
Relationship Of ◽  
The Relationship

The open procedures most commonly performed to treat renovascular disease are aortorenal bypass, renal artery thromboendarterectomy, and renal artery reimplantation. This review discusses preoperative evaluation, operative planning, and the operative technique of the aforementioned procedures. In addition, outcome evaluation is described, including hypertension response, renal function response, and the relationship of these to dialysis-free survival. A table provides the recommended principles for contemporary surgical management of renovascular disease. Figures show various types of bypass procedures. This review contains 10 references plus additional sources of recommended reading.

Repair of Femoral and Popliteal Artery Aneurysms

2020 ◽  
Author(s):  
Patrick J. O'Hara
Keyword(s):  
Femoral Artery ◽  
Endovascular Repair ◽  
Popliteal Artery ◽  
Operative Technique ◽  
Surgical Repair ◽  
Preoperative Evaluation ◽  
Artery Aneurysm ◽  
Outcome Evaluation ◽  
Elective Repair ◽  
Operative Planning

Femoral and popliteal artery aneurysms constitute most peripheral aneurysms. In general, with both femoral and popliteal artery aneurysms, elective repair and reconstruction tend to be associated with significantly better postoperative outcomes than emergency repair undertaken after a limb-threatening complication. Specific treatment decisions may be influenced by the presence or absence of symptoms of aneurysmal disease. For femoral artery aneurysms, this chapter presents the preoperative evaluation, operative planning, operative technique (endovascular repair, ultrasound-guided compression, and open surgical repair), and outcome evaluation. For popliteal aneurysms, this chapter discusses the preoperative evaluation, operative planning (indications for repair and preoperative arterial thrombolysis), operative technique (open vs. endovascular repair), and outcome evaluation (dependent on whether surgical or endovascular).  This review contains 15 figures, 9 tables, and 41 references. Keywords:Lower extremity aneurysm, popliteal artery aneurysm, femoral artery aneurysm, surgical repair, endovascular repair, thrombosis, embolization

Orthognathic Surgery

2019 ◽  
pp. 609-622
Author(s):  
Ryan M. Moore ◽  
Raj M. Vyas
Keyword(s):  
Orthognathic Surgery ◽  
Surgical Planning ◽  
Preoperative Evaluation ◽  
Cephalometric Analysis ◽  
Operative Techniques ◽  
Virtual Surgical Planning ◽  
Bilateral Sagittal Split Osteotomy ◽  
Operative Planning ◽  
Facial Proportions ◽  
Facial Function

Orthognathic surgery restores the facial function and aesthetics affected by skeletal and dental deformities. A comprehensive preoperative evaluation, including cephalometric analysis, is essential to correcting facial skeletal imbalance and asymmetry. Operative planning must account for maxillary-to-mandibular occlusal relationship and dental compensations, as well as facial proportions in all dimensions. Virtual surgical planning has recently emerged as a way to facilitate more precise and accurate surgical planning. Operative techniques used to correct facial skeletal and dental deformities, broadly categorized as maxillary or mandibular excess or deficiency, include the LeFort I osteotomy, bilateral sagittal split osteotomy, and genioplasty.

Repair of Femoral and Popliteal Artery Aneurysms

2020 ◽  
Author(s):  
Patrick J. O'Hara
Keyword(s):  
Femoral Artery ◽  
Endovascular Repair ◽  
Popliteal Artery ◽  
Operative Technique ◽  
Surgical Repair ◽  
Preoperative Evaluation ◽  
Artery Aneurysm ◽  
Outcome Evaluation ◽  
Elective Repair ◽  
Operative Planning

Femoral and popliteal artery aneurysms constitute most peripheral aneurysms. In general, with both femoral and popliteal artery aneurysms, elective repair and reconstruction tend to be associated with significantly better postoperative outcomes than emergency repair undertaken after a limb-threatening complication. Specific treatment decisions may be influenced by the presence or absence of symptoms of aneurysmal disease. For femoral artery aneurysms, this chapter presents the preoperative evaluation, operative planning, operative technique (endovascular repair, ultrasound-guided compression, and open surgical repair), and outcome evaluation. For popliteal aneurysms, this chapter discusses the preoperative evaluation, operative planning (indications for repair and preoperative arterial thrombolysis), operative technique (open vs. endovascular repair), and outcome evaluation (dependent on whether surgical or endovascular).  This review contains 15 figures, 9 tables, and 41 references. Keywords:Lower extremity aneurysm, popliteal artery aneurysm, femoral artery aneurysm, surgical repair, endovascular repair, thrombosis, embolization

scholarly journals Outcomes of Patients with Anastomotic Leakage After Transhiatal, McKeown or Ivor Lewis Esophagectomy: A Nationwide Cohort Study

2021 ◽  
Author(s):  
Moniek H. P. Verstegen ◽  
Annelijn E. Slaman ◽  
Bastiaan R. Klarenbeek ◽  
Mark I. van Berge Henegouwen ◽  
Suzanne S. Gisbertz ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Anastomotic Leakage ◽  
Readmission Rate ◽  
Strong Association ◽  
Postoperative Mortality ◽  
Transhiatal Esophagectomy ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
Operation Rate ◽  
Different Types

Abstract Background Anastomotic leakage has a great impact on clinical outcomes after esophagectomy. It has never been studied whether anastomotic leakage is of equal severity between different types of esophagectomy (i.e., transhiatal, McKeown and Ivor Lewis) in terms of postoperative mortality and morbidity. Methods All esophageal cancer patients with anastomotic leakage after transhiatal, McKeown or Ivor Lewis esophagectomy between 2011 and 2019 were selected from the Dutch Upper Gastrointestinal Cancer Audit (DUCA) registry. The primary outcome was 30-day/in-hospital mortality. Secondary outcomes included postoperative complications, re-operation and ICU readmission rate. Results Data from 1030 patients with anastomotic leakage after transhiatal (n=287), McKeown (n=397) and Ivor Lewis esophagectomy (n=346) were evaluated. The 30-day/in-hospital mortality rate was 4.5% in patients with leakage after transhiatal esophagectomy, 8.1% after McKeown and 8.1% after Ivor Lewis esophagectomy (P=0.139). After correction for confounders, leakage after transhiatal resection was associated with lower mortality (OR 0.152–0.699, P=0.004), but mortality after McKeown and Ivor Lewis esophagectomy was similar. Re-operation rate was 24.0% after transhiatal, 40.6% after McKeown and 41.3% after Ivor Lewis esophagectomy (P<0.001). ICU readmission rate was 24.0% after transhiatal, 37.8% after McKeown and 43.4% after Ivor Lewis esophagectomy (P<0.001). Conclusion This study in patients with anastomotic leakage confirms a strong association between severity of clinical consequences and different types of esophagectomy. It supports the hypothesis that cervical leakage is generally less severe than intrathoracic leakage. The clinical impact of anastomotic leakage should be taken into account, in addition to its incidence, when different types of esophagectomy are compared by clinicians or researchers.

Major modifications to minimize thoracic esophago‐gastric leak and eradicate esophageal stricture after Ivor Lewis esophagectomy

2021 ◽  
Author(s):  
Brian Housman ◽  
Dong‐Seok Lee ◽  
Andrea Wolf ◽  
Daniel Nicastri ◽  
Andrew Kaufman ◽  
...  
Keyword(s):  
Esophageal Stricture ◽  
Gastric Leak ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy

PS02.147: MANAGEMENT OF A SIMULTANEOUS HIGH ESOPHAGO-TRACHEAL FISTULA CAUSED BY ESOPHAGEAL STENT DUE TO ANASTOMOTIC LEAKAGE AFTER IVOR-LEWIS ESOPHAGECTOMY: A CASE REPORT

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 162-162
Author(s):  
Hannah Andrae ◽  
Thomas Musholt ◽  
Hauke Lang ◽  
Peter Grimminger
Keyword(s):  
Case Report ◽  
Anastomotic Leakage ◽  
Healing Process ◽  
Esophageal Stent ◽  
Neoadjuvant Radiochemotherapy ◽  
Carcinoma Of The Esophagus ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
First Choice ◽  
Cervical Surgery

Abstract Background Esophagotracheal perforation is a very severe complication. However, an esophagotracheal perforation caused due to an esophageal stent after anastomotic leakage after ivor-lewis resection, is even more complex and associated with high mortality. Therefore we present a case how we managed a high esophagotracheal perforation and anastomotic leakage after ivor-lewis resection of esophageal cancer, prior treated with neoadjuvant radiochemotherapy. Methods Case report A 71-year old patient was transferred to our center due to an esophagotracheal perforation at the proximal stent—and at 18–20 cm from the front teeth row. The stent had been placed due to anastomotic leakage after ivor-lewis resection. The patient's history began with a squamous cell carcinoma of the esophagus, treated with neoadjuvant radiochemotherapy and followed by ivor-lewis esophagectomy. She developed an anastomotic leakage, which was treated with an esophageal stent. This stent perforated and caused a fistula between the esophagus and the trachea. Results After transfer to our center, we performed a tracheotomia with a tubus blocked, distal of the esophagotracheal fistula, to prevent a respiratory insufficiency. We removed the dislocated stent and induced an endosponge therapy. A prolonged healing process lead to a step-by-step decrease of the anastomotic leakage. Finally, the semicircular hole could be supplied by a fibrin sealant. We resected the fistula via cervical surgery and placed a pectoralis muscle flap between trachea and esophagus. The surgery was performed under steady neuromonitoring control. The postoperative course was uncomplicated. The patient could be extubated with spontaneous breathing. Eleven days after surgery, the patient could be discharged fully enteralised. The stomach interponate could be kept. Half a year later, our patient shows up in our regular consultation, reporting no dysphagia. Conclusion Our experience with endosponge treatment suggests that this is the first choice for successful healing of anastomotic leakage after ivor-lewis resection. A stenting of the esophagus after finding an anastomotic leakage can be considered, but is associated with a risk of further complication. Disclosure All authors have declared no conflicts of interest.

Long-term outcomes after robotic-assisted Ivor Lewis esophagectomy

2021 ◽  
Author(s):  
Pridvi Kandagatla ◽  
Ali Hussein Ghandour ◽  
Ali Amro ◽  
Andrew Popoff ◽  
Zane Hammoud
Keyword(s):  
Long Term Outcomes ◽  
Ivor Lewis ◽  
Robotic Assisted ◽  
Ivor Lewis Esophagectomy
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