HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Andrew C. Chang Allan Pickens Christine L. Lau Mark B. Orringer Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Scipione, C. N. Articles by Orringer, M. B. Search for Related Content PubMed PubMed Citation Articles by Scipione, C. N. Articles by Orringer, M. B. Related Collections Esophagus - cancer

Ann Thorac Surg 2007;84:376-383
© 2007 The Society of Thoracic Surgeons

---

Original Articles: General Thoracic

Transhiatal Esophagectomy in the Profoundly Obese: Implications and Experience

Department of Surgery, Section of Thoracic Surgery, The University of Michigan Medical Center, Ann Arbor, Michigan

Accepted for publication November 21, 2006.

^_* Address correspondence to Dr Orringer, Section of Thoracic Surgery, University of Michigan Medical Center, 1500 E Medical Center Dr, 2120 Taubman Center, Box 0344, Ann Arbor, MI 48109 (Email: morrin{at}umich.edu).

Presented at the Forty-third Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 29–31, 2007.

Background: Historically, obesity contraindicated an abdominal approach to the esophagogastric junction. The technique of transhiatal esophagectomy (THE) evolved without specific regard to body habitus. The dramatic increase in obese patients requiring an esophagectomy for complications of reflux disease prompted this evaluation of the impact of obesity on the outcomes of esophagectomy to determine whether profound obesity should contraindicate the transhiatal approach.

Methods: We used our Esophagectomy Database to identify 133 profoundly obese patients (body mass index [BMI] 35 kg/m²) from among 2176 undergoing a THE from 1977 to 2006. This group was matched to a randomly selected, non-obese (BMI, 18.5 to 30 kg/m²) control population of 133 patients. Intraoperative, postoperative, and long-term follow-up results were compared retrospectively.

Results: Profoundly obese patients had significantly greater intraoperative blood loss (mean, 492.2 mL versus 361.8 mL, p = 0.001), need for partial sternotomy (18 versus 3, p = 0.001), and frequency of recurrent laryngeal nerve injury (6 versus 0, p = 0.04). The two groups did not differ significantly in the occurrence of chylothorax, wound infection, or dehiscence rate; length of hospital stay or need for intensive care unit stay; or hospital or operative mortality. Follow-up results for dysphagia, dumping, regurgitation, and overall functional score were also comparable between the two groups.

Conclusions: With appropriate instrumentation, transhiatal esophagectomy in obese patients has similar morbidity and outcomes as in non-obese patients. Obesity, even when profound, does not contraindicate a transhiatal esophagectomy.

This article has been cited by other articles:

				C. D. Wright, J. C. Kucharczuk, S. M. O'Brien, J. D. Grab, and M. S. Allen Predictors of major morbidity and mortality after esophagectomy for esophageal cancer: a Society of Thoracic Surgeons General Thoracic Surgery Database risk adjustment model. J. Thorac. Cardiovasc. Surg., March 1, 2009; 137(3): 587 - 595. [Abstract] [Full Text] [PDF]

				A. Kilic, M. J. Schuchert, A. Pennathur, K. Yaeger, V. Prasanna, J. D. Luketich, and S. Gilbert Impact of obesity on perioperative outcomes of minimally invasive esophagectomy. Ann. Thorac. Surg., February 1, 2009; 87(2): 412 - 415. [Abstract] [Full Text] [PDF]