title: Thoracoabdominal incision: a forgotten tool in the management of complex upper gastrointestinal complications.
abstract: BACKGROUND
  The gastroesophageal junction was commonly approached surgically through a thoracoabdominal incision. With the advent of improved retraction devices, this has been abandoned because the upper midline incision has provided adequate exposure with decreased morbidity. However, exposure of the gastroesophageal junction remains a challenge in the setting of surgical complications associated with repeat surgeries and abscess formation.
  
  
  METHODS
  Patients were placed in the right lateral decubitus position. An incision was made 2 cm below the tip of the scapula to a point in the midline equidistant from the xiphoid process to the umbilicus. The chest was entered at the eighth intercostal space. The abdominal cavity was entered by dividing the diaphragm peripherally from its lateral attachments to the ribs.
  
  
  RESULTS
  We have used this approach on 4 patients. All patients were discharged home tolerating oral diets. The average postoperative stay was 10 days. No complications related to the incision were reported. At the 6-month follow-up evaluation all patients continued to tolerate a regular diet without difficulties.
  
  
  CONCLUSIONS
  The technique described allows for excellent exposure of the upper gastrointestinal tract in a subset of patients with complex upper gastrointestinal complications.
authors.affiliation: Department of Surgery, Section of Surgical Oncology, Penn State Milton S Hershey Medical Center, Hershey, PA 17033, USA.
authors.forename: Luis Jose
authors.initials: LJ
authors.lastname: Garcia
authors.forename: Diego Mauricio
authors.initials: DM
authors.lastname: Avella
authors.forename: Brett
authors.initials: B
authors.lastname: Hartman
authors.forename: Eric
authors.initials: E
authors.lastname: Kimchi
authors.forename: Kevin Finnbar
authors.initials: KF
authors.lastname: Staveley-O'Carroll
mesh_terms: D000368:Aged; D003106:Colon / Q000637:transplantation; D004935:Esophageal Diseases / Q000601:surgery*; D005260:Female; D005767:Gastrointestinal Diseases / Q000601:surgery; D006801:Humans; D007583:Jejunum / Q000637:transplantation; D007813:Laparotomy; D008875:Middle Aged; D013272:Stomach Diseases / Q000601:surgery*; D013908:Thoracotomy; D041742:Upper Gastrointestinal Tract / Q000601:surgery*