ABSTRACT
The feasibility of removing the esophagus from the posterior mediastinum using an instrument similar to a vein stripper was suggested by the German anatomist Denk in 1913. In 1936, the British surgeon Grey-Turner resected the esophagus for carcinoma through abdominal and cervical incisions. Later, restoration of swallowing was achieved with an antethoracic skin tube. This, and subsequent early reports of transhiatal (or blunt) esophagectomy in which the esophagus was resected through abdominal and cervical incisions without the need for a thoracotomy, occurred before the development of endotracheal anesthesia permitted safe transthoracic operations. As endotracheal anesthesia became widely available, however, the technique was all but abandoned. It was still used at times to resect a normal thoracic esophagus concomitantly with laryngopharyngectomy for pharyngeal or cervical esophageal carcinoma, with the stomach being used to restore continuity of the alimentary tract. In the 1970s, several authors reported the use of transhiatal esophageal resection for diseases of the intrathoracic esophagus. Orringer and associates repopularized the technique in 1978, and during the ensuing two and a half decades, numerous reports have established that transhiatal esophagectomy is a safe alternative to traditional transthoracic esophageal resection. Based upon a personal experience with more than 2000 transhiatal esophagectomies, the author believes that it is unnecessary to open the thorax in the majority of patients requiring esophageal resection for either benign or malignant disease.
