Transhiatal esophagectomy: clinical experience and refinements

To review the authors' clinical experience with transhiatal esophagectomy (THE) and the refinements in this procedure that have evolved. Increased use of THE during the past two decades has generated controversy about the merits and safety of this approach compared with transthoracic esophageal resection. The authors' large THE experience provides a valuable basis for benchmarking data regarding the procedure. The results of THE were analyzed retrospectively using the authors' prospectively established esophageal resection database and follow-up information on these patients. From 1976 to 1998, THE was performed in 1085 patients, 26% with benign disease and 74% with cancer. The procedure was possible in 98.6% of cases. Stomach was the esophageal substitute in 96%. The hospital mortality rate was 4%. Blood loss averaged 689 cc. Major complications were anastomotic leak (13%), atelectasis/pneumonia (2%), intrathoracic hemorrhage, recurrent laryngeal nerve paralysis, chylothorax, and tracheal laceration (