Mckeown Esophagectomy Procedure, Steps, Technique, Compliactions

Mckeown Esophagectomy Procedure, Steps, Technique, Compliactions

The McKeown Esophagectomy is a type of surgical treatment that involves the removal of the esophagus as well as the upper region of the stomach. It’s used to help people who have esophageal cancer or other forms of esophageal illness. The esophagus connects the mouth and the stomach and is responsible for transporting food from the mouth to the stomach.

Mckeown Esophagectomy Procedure

A small piece of the stomach is usually removed during this procedure. The remaining portion of the stomach is subsequently joined to the upper portion of the esophagus. The new esophagus is then created by gently pulling the stomach up towards the chest or neck. Esophagectomy is also used to treat noncancerous diseases such as advanced achalasia and strictures.

This McKeown procedure is comparable in concept to the Ivor Lewis treatment, although it is typically utilized for lesions higher in the esophagus. In comparison to other procedures, it has a decreased rate of stricture, aspiration, and leakage. Transhiatal esophagectomy, Ivor Lewis esophagectomy, and McKeown esophagectomy (which requires three incisions) are all alternative surgical approaches that may be considered in an imaging differential diagnosis.

Mckeown Esophagectomy Procedure, Steps, Technique, Compliactions

Mckeown Esophagectomy Steps

These steps are included in this procedure:

  • Lymph node dissection, thoracic duct ligation, and mobilization of the thoracic esophagus are the main three steps of the McKeown esophagectomy.
  • The six very small incisions are made in the abdominal region to mobilize the stomach by severing a wide variety of attachments, arteries, and ligaments.
  • The stomach is then divided using a stapler to form a gastric conduit or new esophagus.
  • After creating a gastric conduit, ICG angiography is used to assure the perfusion of the new esophagus. This is accomplished by injecting ICG into the bloodstream, which becomes green when observed using the robot’s FIREFLY function.
  • The pylorus, also known as the valve that separates the stomach and the small intestine, is then injected with BOTOX. This opens the valve and allows food to pass from the gastric conduit into the small intestine.
  • Finally, the gastric conduit and esophagus connection are allowed to heal by inserting a jejunostomy tube into the small intestine to provide for feeding.
  • After that, the gastric conduit and the specimen are moved to the left side of the patient’s neck. The specimen is then collected and delivered to pathology for examination. The esophagus is then joined to the gastric conduit.
  • An NG tube, also known as a nasogastric tube, is placed into the gastric conduit via the nose. 

Mckeown Esophagectomy Technique

Da Vinci Xi, the most advanced robotic system, is used to execute McKeown esophagectomy.  A “three-hole esophagectomy” is another name for the procedure, which alludes to the three incisions needed to complete it. The surgery is done through five small cuts on the right side of the chest. The esophagus is separated from its surroundings. The surgeon then removes the lymph nodes that are situated next to the esophagus in the middle of the chest.

A McKeown esophagectomy technique includes thoracic esophageal mobilization, dissection of lymph nodes, closure of the thoracic duct (either thoracoscopically or openly), and abdominal anastomosis. The stomach is mobilized by splitting vessels, ligaments, and attachments. A linear cutting stapler or a sharp incision between the ties is used to divide the azygous vein.

Mckeown Esophagectomy Complications

McKeown esophagectomy, a form of minimally invasive surgery, is known to be an effective and safe method of treating distal esophageal cancer. But, adhesions or variations in anatomy make this procedure risky, and the surgeon often needs to make a standard incision to finish the operation safely. The most prevalent complication of the procedure is the development of pneumonia as a result of inadequate postoperative pulmonary care. Bleeding, infections, atrial fibrillation, leaks at the anastomosis, and liver, stomach, intestine, lung, and spleen injuries are other possible but less common problems. Blood clots in the leg, clots that spread to the lung, heart attacks, and strokes are some of the uncommon complications.

During a McKeown esophagectomy, hemorrhage, and tracheal damage are the two most common intraoperative complications. After esophageal resection, pulmonary problems cause the most morbidity and mortality. Infection, atrial fibrillation, leakage at the anastomosis, and injuries to the liver, stomach, intestine, lung, and spleen are some of the other less common issues that can occur. Complications after surgery are easier to avoid if proper postoperative care is given a high priority.

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