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August 1993

Invited Commentary

Author Affiliations

Sacramento, Calif

Arch Surg. 1993;128(8):902. doi:10.1001/archsurg.1993.01420200076013

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The authors state, "The technique... allows most of the operations on the esophagus to be performed through abdominal and cervical incisions." This claim must be accepted with caution.

My experience, initially working with Dragstedt, employed incision in the retrocardiac diaphragm as our routine approach to the vagus nerves. This supports the authors' contention that transverse, retrocardiac, central diaphragmatic incision, anterior to the phrenic vein, is a useful and safe approach to tissues around the distal esophagus at the cardioesophageal junction. However, one of the keys to more extensive dissection of the distal esophagus is division of the inferior pulmonary ligament, at the base of which one finds the inferior pulmonary vein. Branches of this vein can be torn if exposure of the area is suboptimal. Moreover, extensive exposure of the distal esophagus may require temporary translocation of the heart in elderly patients. Thus, cardiac arrhythmias and transient hypotension may occur

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