Case report
Minimally Invasive Transhiatal Esophagectomy After Thoracotomy

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Patients with end-stage achalasia may not be candidates for a transhiatal minimally invasive esophageal resection because of anatomic challenges and adhesions from previous interventions, namely, thoracotomy. Given the tactile feedback provided through a GelPort laparoscopic system (Applied Medical, Rancho Margarita, CA) we proposed that a minimally invasive transhiatal esophagectomy would be feasible in this patient cohort. The procedure was successful in 4 patients; seven complications occurred in 3 of the patients. At follow-up all patients demonstrated that they were meeting their nutritional needs with an oral diet.

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Case Reports

Our series consists of 4 patients with end-stage achalasia who had undergone various treatments—dilation, botulinum toxin injection, myotomy—for their symptoms.

Comment

Although the mortality from esophageal resection has been minimized in high-volume centers, the associated morbidity remains significant. Various surgical approaches are advocated in specific patients, in an attempt to limit such complications as pneumonia with associated respiratory failure. The transhiatal approach is known to be associated with a lower incidence of respiratory complications compared with the other esophagectomy approaches, which include a thoracic incision. Regardless of the

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