title: Transhiatal esophagectomy in the profoundly obese: implications and experience.
abstract: BACKGROUND
  Historically, obesity contraindicated an abdominal approach to the esophagogastric junction. The technique of transhiatal esophagectomy (THE) evolved without specific regard to body habitus. The dramatic increase in obese patients requiring an esophagectomy for complications of reflux disease prompted this evaluation of the impact of obesity on the outcomes of esophagectomy to determine whether profound obesity should contraindicate the transhiatal approach.
  
  
  METHODS
  We used our Esophagectomy Database to identify 133 profoundly obese patients (body mass index [BMI] > or = 35 kg/m2) from among 2176 undergoing a THE from 1977 to 2006. This group was matched to a randomly selected, non-obese (BMI, 18.5 to 30 kg/m2) control population of 133 patients. Intraoperative, postoperative, and long-term follow-up results were compared retrospectively.
  
  
  RESULTS
  Profoundly obese patients had significantly greater intraoperative blood loss (mean, 492.2 mL versus 361.8 mL, p = 0.001), need for partial sternotomy (18 versus 3, p = 0.001), and frequency of recurrent laryngeal nerve injury (6 versus 0, p = 0.04). The two groups did not differ significantly in the occurrence of chylothorax, wound infection, or dehiscence rate; length of hospital stay or need for intensive care unit stay; or hospital or operative mortality. Follow-up results for dysphagia, dumping, regurgitation, and overall functional score were also comparable between the two groups.
  
  
  CONCLUSIONS
  With appropriate instrumentation, transhiatal esophagectomy in obese patients has similar morbidity and outcomes as in non-obese patients. Obesity, even when profound, does not contraindicate a transhiatal esophagectomy.
authors.affiliation: Department of Surgery, Section of Thoracic Surgery, The University of Michigan Medical Center, Ann Arbor, Michigan 48109, USA.
authors.forename: Christopher N
authors.initials: CN
authors.lastname: Scipione
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Chang
authors.forename: Allan
authors.initials: A
authors.lastname: Pickens
authors.forename: Christine L
authors.initials: CL
authors.lastname: Lau
authors.forename: Mark B
authors.initials: MB
authors.lastname: Orringer
mesh_terms: D016063:Blood Loss, Surgical / Q000503:physiopathology; D015992:Body Mass Index; D016208:Databases, Factual; D016629:Esophagectomy / Q000379:methods* / Q000401:mortality; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care; D009767:Obesity, Morbid / Q000150:complications*; D011184:Postoperative Period; D013249:Sternum / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome