Laparoscopic transhiatal approach for resection of an adenocarcinoma in long-segment Barrett's esophagus.
Barrett's esophagus (BE) is a precursor of esophageal adenocarcinoma and is associated with gastroesophageal reflux disease, which is often preceded by a hiatal hernia. We describe a case of esophageal adenocarcinoma arising in long-segment BE (LSBE) associated with a hiatal hernia that was successfully treated with a laparoscopic transhiatal approach (LTHA) without thoracotomy. The patient was a 42-year-old male who had previously undergone laryngectomy and tracheal separation to avoid repeated aspiration pneumonitis. An ulcerative lesion was found in a hiatal hernia by endoscopy and superficial esophageal cancer was also detected in the lower thoracic esophagus. The histopathological diagnosis of biopsy samples from both lesions was adenocarcinoma. There were difficulties with the thoracic approach because the patient had severe kyphosis and muscular contractures from cerebral palsy. Therefore, we performed subtotal esophagectomy by LTHA without thoracotomy. Using hand-assisted laparoscopic surgery, the esophageal hiatus was divided and carbon dioxide was introduced into the mediastinum. A hernial sac was identified on the cranial side of the right crus of the diaphragm and carefully separated from the surrounding tissues. Abruption of the thoracic esophagus was performed up to the level of the arch of the azygos vein via LTHA. A cervical incision was made in the left side of the permanent tracheal stoma, the cervical esophagus was divided, and gastric tube reconstruction was performed via a posterior mediastinal route. The operative time was 175 min, and there was 61 mL of intra-operative bleeding. A histopathological examination revealed superficial adenocarcinoma in LSBE. Our surgical procedure provided a good surgical view and can be safely applied to patients with a hiatal hernia and kyphosis.
Atsushi Shiozaki, Hitoshi Fujiwara, Hirotaka Konishi, Osamu Kinoshita, Toshiyuki Kosuga, Ryo Morimura, Yasutoshi Murayama, Shuhei Komatsu, Yoshiaki Kuriu, Hisashi Ikoma, Masayoshi Nakanishi, Daisuke Ichikawa, Kazuma Okamoto, Chouhei Sakakura, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
Atsushi
A
Shiozaki
Atsushi Shiozaki, Hitoshi Fujiwara, Hirotaka Konishi, Osamu Kinoshita, Toshiyuki Kosuga, Ryo Morimura, Yasutoshi Murayama, Shuhei Komatsu, Yoshiaki Kuriu, Hisashi Ikoma, Masayoshi Nakanishi, Daisuke Ichikawa, Kazuma Okamoto, Chouhei Sakakura, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
Hitoshi
H
Fujiwara
Atsushi Shiozaki, Hitoshi Fujiwara, Hirotaka Konishi, Osamu Kinoshita, Toshiyuki Kosuga, Ryo Morimura, Yasutoshi Murayama, Shuhei Komatsu, Yoshiaki Kuriu, Hisashi Ikoma, Masayoshi Nakanishi, Daisuke Ichikawa, Kazuma Okamoto, Chouhei Sakakura, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
Hirotaka
H
Konishi
Atsushi Shiozaki, Hitoshi Fujiwara, Hirotaka Konishi, Osamu Kinoshita, Toshiyuki Kosuga, Ryo Morimura, Yasutoshi Murayama, Shuhei Komatsu, Yoshiaki Kuriu, Hisashi Ikoma, Masayoshi Nakanishi, Daisuke Ichikawa, Kazuma Okamoto, Chouhei Sakakura, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
Osamu
O
Kinoshita
Atsushi Shiozaki, Hitoshi Fujiwara, Hirotaka Konishi, Osamu Kinoshita, Toshiyuki Kosuga, Ryo Morimura, Yasutoshi Murayama, Shuhei Komatsu, Yoshiaki Kuriu, Hisashi Ikoma, Masayoshi Nakanishi, Daisuke Ichikawa, Kazuma Okamoto, Chouhei Sakakura, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
Toshiyuki
T
Kosuga
Atsushi Shiozaki, Hitoshi Fujiwara, Hirotaka Konishi, Osamu Kinoshita, Toshiyuki Kosuga, Ryo Morimura, Yasutoshi Murayama, Shuhei Komatsu, Yoshiaki Kuriu, Hisashi Ikoma, Masayoshi Nakanishi, Daisuke Ichikawa, Kazuma Okamoto, Chouhei Sakakura, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
Ryo
R
Morimura
Atsushi Shiozaki, Hitoshi Fujiwara, Hirotaka Konishi, Osamu Kinoshita, Toshiyuki Kosuga, Ryo Morimura, Yasutoshi Murayama, Shuhei Komatsu, Yoshiaki Kuriu, Hisashi Ikoma, Masayoshi Nakanishi, Daisuke Ichikawa, Kazuma Okamoto, Chouhei Sakakura, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
Yasutoshi
Y
Murayama
Atsushi Shiozaki, Hitoshi Fujiwara, Hirotaka Konishi, Osamu Kinoshita, Toshiyuki Kosuga, Ryo Morimura, Yasutoshi Murayama, Shuhei Komatsu, Yoshiaki Kuriu, Hisashi Ikoma, Masayoshi Nakanishi, Daisuke Ichikawa, Kazuma Okamoto, Chouhei Sakakura, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
Shuhei
S
Komatsu
Atsushi Shiozaki, Hitoshi Fujiwara, Hirotaka Konishi, Osamu Kinoshita, Toshiyuki Kosuga, Ryo Morimura, Yasutoshi Murayama, Shuhei Komatsu, Yoshiaki Kuriu, Hisashi Ikoma, Masayoshi Nakanishi, Daisuke Ichikawa, Kazuma Okamoto, Chouhei Sakakura, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
Yoshiaki
Y
Kuriu
Atsushi Shiozaki, Hitoshi Fujiwara, Hirotaka Konishi, Osamu Kinoshita, Toshiyuki Kosuga, Ryo Morimura, Yasutoshi Murayama, Shuhei Komatsu, Yoshiaki Kuriu, Hisashi Ikoma, Masayoshi Nakanishi, Daisuke Ichikawa, Kazuma Okamoto, Chouhei Sakakura, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
Hisashi
H
Ikoma
Atsushi Shiozaki, Hitoshi Fujiwara, Hirotaka Konishi, Osamu Kinoshita, Toshiyuki Kosuga, Ryo Morimura, Yasutoshi Murayama, Shuhei Komatsu, Yoshiaki Kuriu, Hisashi Ikoma, Masayoshi Nakanishi, Daisuke Ichikawa, Kazuma Okamoto, Chouhei Sakakura, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
Masayoshi
M
Nakanishi
Atsushi Shiozaki, Hitoshi Fujiwara, Hirotaka Konishi, Osamu Kinoshita, Toshiyuki Kosuga, Ryo Morimura, Yasutoshi Murayama, Shuhei Komatsu, Yoshiaki Kuriu, Hisashi Ikoma, Masayoshi Nakanishi, Daisuke Ichikawa, Kazuma Okamoto, Chouhei Sakakura, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
Daisuke
D
Ichikawa
Atsushi Shiozaki, Hitoshi Fujiwara, Hirotaka Konishi, Osamu Kinoshita, Toshiyuki Kosuga, Ryo Morimura, Yasutoshi Murayama, Shuhei Komatsu, Yoshiaki Kuriu, Hisashi Ikoma, Masayoshi Nakanishi, Daisuke Ichikawa, Kazuma Okamoto, Chouhei Sakakura, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
Kazuma
K
Okamoto
Atsushi Shiozaki, Hitoshi Fujiwara, Hirotaka Konishi, Osamu Kinoshita, Toshiyuki Kosuga, Ryo Morimura, Yasutoshi Murayama, Shuhei Komatsu, Yoshiaki Kuriu, Hisashi Ikoma, Masayoshi Nakanishi, Daisuke Ichikawa, Kazuma Okamoto, Chouhei Sakakura, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
Chouhei
C
Sakakura
Atsushi Shiozaki, Hitoshi Fujiwara, Hirotaka Konishi, Osamu Kinoshita, Toshiyuki Kosuga, Ryo Morimura, Yasutoshi Murayama, Shuhei Komatsu, Yoshiaki Kuriu, Hisashi Ikoma, Masayoshi Nakanishi, Daisuke Ichikawa, Kazuma Okamoto, Chouhei Sakakura, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
Eigo
E
Otsuji
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D001471:Barrett Esophagus / Q000473:pathology / Q000601:surgery*; D001706:Biopsy; D016063:Blood Loss, Surgical; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D058733:Hand-Assisted Laparoscopy / Q000379:methods*; D006551:Hernia, Hiatal / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D061646:Operative Time; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
Barrett’s esophageal carcinoma; Hiatal hernia; Laparoscopic transhiatal approach