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General Surgery
Esophagus
Built from Skandalakis' Surgical Anatomy: The Embryologic and Anatomic Basis of Modern Surgery
What’s inside
16 sections · 198 slides
Overview
- Scope of this topic
Historical landmarks
- Milestones in esophageal surgery
- Anatomic and Surgical History of the Esophagus
- Anatomic and Surgical History of the Esophagus (continued)
- Anatomic and Surgical History of the Esophagus (continued)
- Anatomic and Surgical History of the Esophagus (continued)
- Anatomic and Surgical History of the Esophagus (continued)
- Anatomic and Surgical History of the Esophagus (continued)
- Anatomic and Surgical History of the Esophagus (continued)
Development of the esophagus
- Formation of the primitive foregut
- Division of the primitive foregut
- Embryonic gut and descent of the stomach
- Events at the thirty-fourth day
- Timetable of esophageal wall differentiation
- Formation of the esophageal lumen
- Changing shape of the esophageal lumen
- Epithelial transformation and early innervation
- Foregut to definitive esophagus
- Third branchial arch derivatives
- Fourth and sixth branchial arch derivatives
- Origin of the inferior thyroid artery
- Congenital anomalies of the esophagus
- Sites of esophageal malformations and heterotopic mucosa
- Anomalies of the Esophagus
- Anomalies of the Esophagus (continued)
- Surgical repair of congenital anomalies
Terminology, position and dimensions
- Etymology of the term esophagus
- Position of the esophagus
- Three ways of dividing the esophagus
- The functional division into motility zones
- The surgical two-part division
- Rationale for the surgical division
- Divisions, terminology and relationships of the esophagus
- Configuration and calibre of the esophagus
- Relationship of esophagus to trachea in cross section
- Deviations of the esophageal axis
- Length of the esophagus and its segments
- Endoscopic and manometric distances from the incisors
Structure of the esophageal wall
- The four layers of the esophageal wall
- Tissue organisation of esophagus, junction and stomach
- Endoscopic appearance of the esophageal mucosa
- The Z-line
- Esophagogastric junction viewed from the luminal aspect
- Barrett's esophagus
- Apoptosis in Barrett's esophagus
- Management points in Barrett's esophagus
- Lamina propria and muscularis mucosae
- Mucosal folds along the esophagus
- Tela submucosa
Musculature of the esophagus
- Pharyngeal versus esophageal muscle arrangement
- Muscle bundles at the pharyngoesophageal junction
- Change of fibre direction at the pharyngoesophageal junction
- Musculature of pharynx, esophagus and stomach from the left
- Transition from striated to smooth muscle
- Where striated muscle ends
- Distribution of striated and smooth muscle in the adult esophagus
- Thickness and orientation of the muscle layers
- The longitudinal muscle layer
- The circular muscle layer
- Laimer's bracket fibres
The esophageal sphincters
- General features of a sphincter
- Structures of the pharyngoesophageal region
- Structures involved in swallowing, breathing and speech
- Anatomy of the upper esophageal sphincter
- Muscle bulk and function of the upper sphincter
- Laryngopharynx and cervical esophagus from behind
- Muscular thickening of the lower esophageal sphincter
- Gastric sling fibres
- Clasp fibres of the lesser curvature
- Gastric sling and clasp fibres at the junction
- Thickness of the tunica muscularis across the junction
- Muscle thickness and the three-dimensional pressure image
- Why the junctional thickening escapes palpation
- Sphincter dimensions and resting pressures
- Killian's triangle and Zenker's diverticulum
- Lateral diverticula and treatment of Zenker's diverticulum
- Diaphragmatic crura and the lower sphincter
Adventitia, anchorage and spaces
- Tunica adventitia and the tissue mantle
- Blunt stripping and spread of disease
- Framework stabilising pharynx and esophagus
- Anchoring and stabilising structures of esophagus and stomach
- Anchorage of the tubular esophagus
- Dimensions of the anchoring membranes
- Fibre membrane connecting esophagus with trachea
- Clinical relevance of the anchoring membranes
- The phrenoesophageal membrane
- Lower leaflet and operative recognition
- Ageing of the phrenoesophageal membrane
- Anatomic factors in hiatal hernia
- Sliding and paraesophageal hiatal hernia
- Compartments and fascial spaces
- Consequences of perforation and anastomotic leak
- The three esophageal constrictions
- Extrinsic and intrinsic supporting structures
Arterial supply
- Blood loss during blunt esophageal stripping
- Arteries of the pharynx and cervical esophagus
- Branching pattern and cervical variants
- Arterial supply of the esophagus
- Arteries of the intrathoracic esophagus
- The aortic proper esophageal artery
- Arteries of the abdominal esophagus and cardia
- Common Extrinsic Blood Sources of the Esophagus
- Intramural arteries
- Surgical significance of the submucosal network
Venous drainage
- Intramural venous plexuses
- Extrinsic venous drainage
- Venous drainage of the esophagus
- Laryngopharyngeal venous plexuses
- Clinical correlates of the laryngopharyngeal plexuses
- Laryngopharyngeal venous plexuses from behind
- The palisade zone at the terminal esophagus
- Venous zones at the esophagogastric junction
- Management of esophageal varices
Lymphatic drainage
- Limits of knowledge of esophageal lymphatics
- Initial lymphatics at the mucosa-submucosa border, light microscopy
- Initial lymphatics at the mucosa-submucosa border, electron microscopy
- Origin of the initial lymphatic network
- The submucosal lymphatic network
- Local lymphatic drainage within the esophageal wall
- Lymph nodes around the esophagus
- Lymphatic pathways of the esophagus
- Longitudinal submucosal tumour spread
- Implications for the resection margin
- Prognostic and treatment observations in esophageal cancer
Innervation
- Autonomic supply of pharynx, larynx and esophagus
- Sympathetic supply of the esophagus
- Vagal supply of the esophagus
- Innervation of the esophagus
- Superior and recurrent laryngeal nerves
- Branches of the superior laryngeal nerve
- Course of the recurrent laryngeal nerves
- Relations of the recurrent nerve in the neck
- Terminal branch of the recurrent laryngeal nerve
- Recurrent laryngeal nerve and the inferior thyroid artery
- Esophageal plexus and the vagal trunks
- Vagal trunks at the hiatus
- Injury to the laryngeal nerves
- Recurrent nerve injury in transhiatal esophagectomy
- Vocal cord paralysis after esophagectomy
- Vagal injury and lower sphincter function
- Preoperative assessment for esophagectomy
Surgery for gastroesophageal reflux
- The antireflux debate
- Nissen and Toupet fundoplication
- Partial fundoplication for impaired motility
- Fixation, crural closure and failure of the wrap
- Limits of antireflux surgery
- Mortality of gastroesophageal reflux disease
- Technique of laparoscopic antireflux repair
- Laparoscopic against open fundoplication
- Complications, reoperation and special situations
- Fundoplication in children and in abnormal motility
- Frequency of Minor Complications Stratified by Primary Operations and Reoperations
- Frequency of Major Complications Stratified by Primary Operations and Reoperations
Esophagectomy for carcinoma
- Controversies in resection for carcinoma
- Transthoracic and transhiatal approaches compared
- The case for transhiatal esophagectomy
- Radical transhiatal resection with endodissection
- Extent of lymphadenectomy and of resection
- Neoadjuvant therapy and local control
- Proximal esophagectomy at the cervicothoracic junction
- Larynx preservation and resectability
- Cervical esophagogastric anastomosis
Replacing the esophagus
- Stomach as the preferred substitute
- Lengthening the stomach by a longitudinal cut
- Mobilisation of the greater curve of the stomach
- Supercharging the gastric conduit
- Colon as an esophageal substitute
- Colon replacement of the esophagus
- Small bowel and skin as substitutes
- Reconstruction after total gastrectomy
- Anatomic Complications of Esophageal Surgery
- Anatomic Complications of Esophageal Surgery (continued)
- Anatomic Complications of Esophageal Surgery (continued)
- Anatomic Complications of Esophageal Surgery (continued)
- Anatomic Complications of Esophageal Surgery: organ injury
- Anatomic Complications of Esophageal Surgery: organ injury (continued)
Summary
- Structural facts that govern esophageal surgery
- Vascular and lymphatic principles
- Nerves, junction and reconstruction
- Sources cited in this topic
- Sources cited in this topic (continued)
- Skandalakis' Surgical Anatomy: The Embryologic and Anatomic Basis of Modern Surgery
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