title: Secure hemostasis in transhiatal esophagectomy for esophageal cancer with gauze packing.
abstract: BACKGROUND
  Transhiatal esophagectomy for esophageal cancer implies blind manipulation of the intrathoracic esophagus. We report a secure hemostatic method with gauze packing in transhiatal esophagectomy.
  
  
  METHODS
  The gauze-packing technique is utilized for hemostasis just after removal of the thoracic esophagus during transhiatal esophagectomy. After confirming cancer-free margins, the abdominal esophagus and cervical esophagus are transected. A vein stripper is inserted into the oral-side stump of the esophagus and led to exit from the abdominal-side stump of the esophagus. The vein stripper and the oral stump of the esophagus are affixed by silk thread. A polyester tape is then affixed to the vein stripper, as the polyester tape is left in the posterior mediastinum after removal of the esophagus toward the abdominal side. The polyester tape on the cervical side is ligated with gauze and the polyester tape is removed toward the abdominal side. The oral stump of gauze and new additional gauze are affixed. As the first gauze is pulled out from the abdominal side, the second gauze gets drawn from the cervical wound into the mediastinum. The posterior mediastinum is finally packed with gauze and possible bleeding at this site undergoes a complete astriction. The status of hemostasis with the gauze packing is checked by an observation of color and bloodstain on the gauze.
  
  
  RESULTS
  Between January 2005 and February 2012, 13 consecutive patients with esophageal cancer underwent a transhiatal esophagectomy with the gauze-packing hemostatic technique. Hemostasis at the posterior mediastinum was performed successfully and quickly in all cases with this method, requiring up to four pieces of gauze for a complete hemostasis. Median required time for hemostasis was 1219 (range 1896 to 1293) seconds and estimated blood loss was 20.4 (range 15 to 25) ml during gauze packing.
  
  
  CONCLUSIONS
  Our technique could minimize bleeding after the removal of the thoracic esophagus. The gauze-packing method is a simple and easy technique for secure hemostasis when performing a transhiatal esophagectomy.
authors.affiliation: Department of Digestive and General Surgery, Shimane University, Izumo, Shimane, Japan. norinorihirahara@yahoo.co.jp
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Hirahara
authors.forename: Takeshi
authors.initials: T
authors.lastname: Matsubara
authors.forename: Yoko
authors.initials: Y
authors.lastname: Hari
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Fujii
authors.forename: Hitomi
authors.initials: H
authors.lastname: Wake
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Tajima
mesh_terms: D001458:Bandages; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D013630:Tampons, Surgical; D016896:Treatment Outcome