Complications during and following esophageal surgery can be extremely morbid, challenging, and frustrating for both the patient and the surgeon. The significance of these complications is related, not only to their relatively high incidence but also to the high morbidity and mortality associated with them. Advances in minimally invasive and endoscopic approaches over the past few decades have led to an increase in surgical indications for esophageal diseases, and also to the development of new diagnostic and therapeutic strategies in the management of complications, allowing the thoracic surgeon to intervene earlier and more effectively.
Given the relative complexity of these patients, it is fundamental to understand the mechanisms that contribute to complications in order to prevent, diagnose, and treat them appropriately, using the best technological and technical options available. In this chapter, we analyze the causes, diagnostic, and treatment alternatives for the most common complications in esophageal surgery.
The esophagus is a muscular structure approximately 25 cm in length that connects the pharynx with the stomach. It traverses the neck, chest, and abdomen. The upper limit of the tube proximally is the level of the lower border of the cricoid cartilage and it descends through the posterior mediastinum between the vertebral column posteriorly and the trachea anteriorly. The intrathoracic portion is limited inferiorly by the diaphragmatic hiatus. In the chest the esophagus descends anterior to the spine, and posterior to the membranous portion of the trachea, the carina, and the left mainstem bronchus. The arch of the aorta lies on the left side of the proximal thoracic third, and the descending aorta lies posteriorly in the mid and distal third. After exiting in the abdomen through the diaphragmatic hiatus, it connects with the stomach. The abdominal portion is typically approximately 2 cm.
The esophagus is limited in its entire anatomy by two areas of high pressure, or sphincters, that maintain a positive pressure in the lumen despite the negative intrathoracic pressure, and prevent the continuous entrance of air from the mouth and gastric content from the distal end. Any alteration of these defensive structures will change the normal physiology, and with a resultant functional modification in the anti-reflux and normal swallowing mechanisms.
The thoracic duct is the largest lymphatic structure in the body and lies next to the esophagus along most of its extension. The diameter of the tubular duct is 2 to 3 mm in width and 40 cm in length. It arises from the cisterna chyli in the abdomen behind the liver. The duct enters the chest through the aortic orifice of the diaphragm and runs between the aorta and the esophagus to the right side of the spine. At the level of the arch of the aorta, it crosses the midline and ascends on the left side of the column until it terminates at the junction between the left subclavian and ...