Emergency transhiatal oesophagectomy for instrumental perforation of an obstructed thoracic oesophagus

Between 1986 and 1994, 14 patients underwent emergency transhiatal oesophagectomy for iatrogenic instrumental perforation of the oesophagus. Continuity of the alimentary tract was restored immediately with cervical anastomosis by oesophagogastroplasty in 13 and oesophagocoloplasty in one. Six patients had oesophageal perforation with a carcinoma, seven had corrosive strictures, and cardiac achalasia was present in one. Only five patients underwent operation within 24 h of initial trauma. There were two postoperative deaths. Resectional surgery, though aggressive, has given good results for perforations with oesophageal strictures. Transhiatal subtotal oesophagectomy has both theoretical and practical advantages over transthoracic resection in the management of instrumental perforation with a distal stricture.