By Carol E.H. Scott-Conner
Chassin’s Operative recommendations in Esophageal surgical procedure bargains the reader a succinct overview of surgical concepts for issues of the esophagus. Spanning from well-established legacy strategies to the main updated minimally invasive ways for GERD, this brilliantly illustrated atlas solely provides the theoretical foundation of the operations in addition to the ideas required to lead away from universal pitfalls. Educed from Chassin’s Operative innovations commonly surgical procedure, this quantity contains step by step descriptions of 13 (13) operative tactics in esophageal surgical procedure.
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Extra info for Chassin's Operative Strategy in Esophageal Surgery
3–17 Make an incision with the scalpel ﬂush with the stapler attached to the residual gastric pouch. If two 90 mm linear staplers are not available, the ﬁrst stapler should be applied to the stomach, ﬁred, and then reapplied 1 cm lower on the gastric wall. The transection should be made ﬂush with the stapler on the gastric pouch. Control individual bleeding vessels with electrocautery after removing the device. The gastric wall is of variable thickness, and we have seen isolated leakage from this staple line when it was not reinforced.
3–25 51 52 Esophagogastrectomy Enter the space between the anterior wall of the esophagus and the aortic arch with the index ﬁnger (Figs. There are no vascular attachments in this area. The index ﬁnger emerges cephalad to the aortic arch behind the mediastinal pleura. Incise the mediastinal pleura on the index ﬁnger, making a window extending along the anterior surface of the esophagus up to the thoracic inlet. Now dissect the esophagus free of all its attachments to the mediastinum in the vicinity of the aortic arch.
Extend the skin incision up from the tip of the scapula in a cephalad direction between the scapula and the spine. With electrocautery divide the rhomboid and trapezium muscles medial to the scapula. Retract the scapula in a cephalad direction and free the erector spinal muscle from the necks of the sixth and ﬁfth ribs. Free a short (1 cm) segment of the sixth (and often of the ﬁfth) rib of its surrounding periosteum and excise it (Fig. 3–23). Divide and ligate or electrocoagulate the intercostal nerves with their accompanying vessels (Fig.