[Subtotal esophagectomy with simultaneous retromediastinal plastic surgery using gastric pedicled flap without thoracotomy].

Thirty-three operations for subtotal esophagectomy with one-stage plastics with a gastric pedicle without thoracotomy were carried out between 1985 and 1988. The indications for the operation were as follows: carcinoma of the esophagus (17) and of cardioesophageal localization (7), cicatricial stricture of the esophagus (6), IV degree cardiospasm (2), unspecific esophageal ulcer (1). The esophagus was resected through a laparotomo-transdiaphragmatic-cervical access, the graft formed from the greater curvature of the stomach was passed in the posterior mediastinum with the establishment of a cervical esophagogastroanastomosis. Postoperative complications occurred in 29 patients: incompetence of the anastomosis (26), mediastinitis and pyothorax, (4), peritonitis (2), pneumonia (4). Six patients died. With the performance of intrapleural esophagogastroplasty the mortality rate fell from 25 to 18.2%. The authors claim that subtotal esophagectomy with posteromediastinal gastroplasty without thoracotomy is a less traumatic and safer operative intervention.