Esophageal Surgery

CHAPTER 80 Esophageal Surgery



David E. Freeman


Esophageal surgery should be performed only on carefully selected horses after conservative treatments have been fully explored. The relatively poor healing of esophageal repairs can be attributed to excessive motion during swallowing and respiration, poor suture holding in esophageal muscle and mucosa, and the absence of a serosal layer to seal anastomotic leaks. Also, horses feed over long periods, ingest coarse and abrasive food, and the intrathoracic portion of the esophagus must empty against gravity. The esophageal lumen diameter is small in horses relative to that of other animals, and additional narrowing from anastomosis, scarring, or stricture formation is poorly tolerated. The length of the horse’s esophagus means that dislodgement of an impacted bolus or foreign body in an aboral direction poses considerable risk for reimpaction distally.



APPROACHES TO THE ESOPHAGUS


Some procedures, such as esophagostomy and esophagotomy, can be performed on the caudal half of the cervical esophagus on a conscious horse after the surgical site has been infiltrated with a local anesthetic. However, more complicated procedures should be undertaken with the anesthetized horse in lateral or dorsal recumbency. A stomach tube should be placed in the esophagus before surgery so it can be identified without an inordinate amount of dissection into surrounding tissue planes. The cranial part of the cervical portion of the esophagus is situated dorsal to the trachea and is most readily approached from the lateral aspect through an incision dorsal to the jugular vein and continued through a layer of fascia that arises from the cutaneous colli muscle. The esophagus is separated from the common carotid artery, vagosympathetic trunk, and recurrent laryngeal nerve, which are at risk of injury through this approach. The cervical portion of the esophagus can also be approached from the ventral midline, although it is more difficult to exteriorize through such an incision in the more cranial portion. However, the critical advantage is that ventral drainage can be established if needed, and damage to the jugular vein and adjacent nerves can be avoided. The thoracic portion of the esophagus can be approached through a left thoracotomy made in an intercostal space or through a rib resection at the level of the lesion. The abdominal portion of the esophagus and lower esophageal sphincter can be exposed through a thoracotomy approach in the 11th intercostal space. A vertical incision is made in the central tendon of the diaphragm close to the esophageal hiatus and a finger is passed through the incision to free the esophagus from its hiatal attachments.



ESOPHAGOTOMY


Esophagotomy is used to remove foreign bodies after noninvasive procedures, such as water lavage under pressure in the anesthetized horse, have failed (see Chapter 78

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May 28, 2016 | Posted by in EQUINE MEDICINE | Comments Off on Esophageal Surgery

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