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Cervical Esophagostomy

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Abstract

CERVICAL esophagostomy is useful in patients who require prolonged tube feedings. Klopp1 utilized this approach in the treatment of an obstructing esophageal carcinoma. Although routinely employed by a few surgeons, notably Ketcham2 who reported 168 esophagostomies, most surgeons are not acquainted with this procedure and therefore perform the conventional gastrostomy. We have found cervical esophagostomy to be of special benefit, and therefore present a description of the technic and a discussion of its use.

Technic

It is helpful to insert a nasogastric catheter preoperatively. Through a short incision two fingerbreadths above and parallel to the clavicle (Fig. 1A) the anterior border of the sternocleidomastoid muscle is exposed. It is important to avoid an incision too high in the neck, as the area of esophagus to be opened should be retrotracheal. The investing fascia is opened sharply, and by blunt dissection the sternocleidomastoid muscle is retracted laterally. The areolar tissues are spread, and the contents of the carotid sheath are retracted laterally until a finger inserted into the incision in a posteromedial direction contacts the prominence of the seventh vertebral body. The thyrolaryngeal structures and trachea are anteromedial to the field of dissection.

The surgeon’s index finger easily feels the preoperatively placed nasogastric tube in the esophagus (Fig. 1B). With gentle finger dissection the esophagus is mobilized behind the upper trachea. The esophageal wall is grasped or held with traction sutures, and an incision is made large enough to admit a 16-French Levin tube which is advanced into the stomach.


 

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