Skip to Main Content

1. Objective esophageal physiology testing is cornerstone to making the diagnosis of benign esophageal disorders and in developing an individualized treatment plan for patients.

2. While most esophageal procedures can be performed using either a videoscopic or flexible endoscopic approach, the surgeon must be familiar with the surgical anatomy and open approaches to the esophagus along its entire length.

3. Laparoscopic cardiomyotomy is now considered the most effective treatment for achalasia and should include division of the gastric collar sling musculature.

4. While esophageal replacement is most commonly performed with the tubularized stomach, the surgeon should be familiar with the anatomy and techniques which enable the use of colon and jejunum.

5. Giant paraesophageal hernia should be repaired surgically in patients with symptoms, anemia, or signs of strangulation.

6. The cornerstone to esophageal cancer clinical staging includes the use of endoscopy, CT, PET, and endoscopic ultrasound.

7. In surgical candidates with esophageal cancer confined to the posterior mediastinum, esophagectomy represents the best possible chance for cure.

The esophagus is a muscular tube that starts as the continuation of the pharynx and ends as the cardia of the stomach. When the head is in a normal anatomic position, the transition from pharynx to esophagus occurs at the lower border of the sixth cervical vertebra. Topographically this corresponds to the cricoid cartilage anteriorly and the palpable transverse process of the sixth cervical vertebra laterally (Fig. 25-1). The esophagus is firmly attached at its upper end to the cricoid cartilage and at its lower end to the diaphragm; during swallowing, the proximal points of fixation move craniad the distance of one cervical vertebral body.

Fig. 25-1.

A. Topographic relationships of the cervical esophagus: (a) hyoid bone, (b) thyroid cartilage, (c) cricoid cartilage, (d) thyroid gland, (e) sternoclavicular. B. Lateral radiographic appearance with landmarks identified as labeled in A. The location of C6 is also included (f).

[Reproduced with permission from Rothberg M, DeMeester TR: Surgical anatomy of the esophagus, in Shields TW (ed): General Thoracic Surgery, 3rd ed. Philadelphia: Lea & Febiger, 1989, p 77.]

The esophagus lies in the midline, with a deviation to the left in the lower portion of the neck and upper portion of the thorax, and returns to the midline in the midportion of the thorax near the bifurcation of the trachea (Fig. 25-2). In the lower portion of the thorax, the esophagus again deviates to the left and anteriorly to pass through the diaphragmatic hiatus.

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.