Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 7, 2015; 21(29): 8974-8980
Published online Aug 7, 2015. doi: 10.3748/wjg.v21.i29.8974
Laparoscopic transhiatal approach for resection of an adenocarcinoma in long-segment Barrett’s esophagus
Atsushi Shiozaki, Hitoshi Fujiwara, Hirotaka Konishi, Osamu Kinoshita, Toshiyuki Kosuga, Ryo Morimura, Yasutoshi Murayama, Shuhei Komatsu, Yoshiaki Kuriu, Hisashi Ikoma, Masayoshi Nakanishi, Daisuke Ichikawa, Kazuma Okamoto, Chouhei Sakakura, Eigo Otsuji
Atsushi Shiozaki, Hitoshi Fujiwara, Hirotaka Konishi, Osamu Kinoshita, Toshiyuki Kosuga, Ryo Morimura, Yasutoshi Murayama, Shuhei Komatsu, Yoshiaki Kuriu, Hisashi Ikoma, Masayoshi Nakanishi, Daisuke Ichikawa, Kazuma Okamoto, Chouhei Sakakura, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
Author contributions: Shiozaki A designed the research and wrote the manuscript; Shiozaki A, Fujiwara H and Konishi H performed the operation; Kinoshita O analyzed the clinicopathological data; Kosuga T, Morimura R, Murayama Y, Komatsu S, Kuriu Y, Ikoma H, Nakanishi M, Ichikawa D, Okamoto K and Sakakura C looked after the patient; and Otsuji E helped edit the manuscript.
Institutional review board statement: The study on this surgical procedure was reviewed and approved by the Kyoto Prefectural University of Medicine Institutional Review Board.
Informed consent statement: The patient provided informed written consent prior to study enrollment.
Conflict-of-interest statement: None of the authors have conflicts of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Atsushi Shiozaki, Assistant Professor, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan. shiozaki@koto.kpu-m.ac.jp
Telephone: +81-75-251-5527 Fax: +81-75-251-5522
Received: December 22, 2014
Peer-review started: December 23, 2014
First decision: March 10, 2015
Revised: April 3, 2015
Accepted: May 21, 2015
Article in press: May 21, 2015
Published online: August 7, 2015
Abstract

Barrett’s esophagus (BE) is a precursor of esophageal adenocarcinoma and is associated with gastroesophageal reflux disease, which is often preceded by a hiatal hernia. We describe a case of esophageal adenocarcinoma arising in long-segment BE (LSBE) associated with a hiatal hernia that was successfully treated with a laparoscopic transhiatal approach (LTHA) without thoracotomy. The patient was a 42-year-old male who had previously undergone laryngectomy and tracheal separation to avoid repeated aspiration pneumonitis. An ulcerative lesion was found in a hiatal hernia by endoscopy and superficial esophageal cancer was also detected in the lower thoracic esophagus. The histopathological diagnosis of biopsy samples from both lesions was adenocarcinoma. There were difficulties with the thoracic approach because the patient had severe kyphosis and muscular contractures from cerebral palsy. Therefore, we performed subtotal esophagectomy by LTHA without thoracotomy. Using hand-assisted laparoscopic surgery, the esophageal hiatus was divided and carbon dioxide was introduced into the mediastinum. A hernial sac was identified on the cranial side of the right crus of the diaphragm and carefully separated from the surrounding tissues. Abruption of the thoracic esophagus was performed up to the level of the arch of the azygos vein via LTHA. A cervical incision was made in the left side of the permanent tracheal stoma, the cervical esophagus was divided, and gastric tube reconstruction was performed via a posterior mediastinal route. The operative time was 175 min, and there was 61 mL of intra-operative bleeding. A histopathological examination revealed superficial adenocarcinoma in LSBE. Our surgical procedure provided a good surgical view and can be safely applied to patients with a hiatal hernia and kyphosis.

Keywords: Laparoscopic transhiatal approach, Barrett’s esophageal carcinoma, Hiatal hernia

Core tip: This report describes a case of esophageal adenocarcinoma arising in long-segment Barrett's esophagus associated with a hiatal hernia that was successfully treated with a laparoscopic transhiatal approach without thoracotomy. This surgical procedure provided a good surgical view and can be safely applied to patients with a hiatal hernia and kyphosis.