Thoracoabdominal incision: a forgotten tool in the management of complex upper gastrointestinal complications

BackgroundThe gastroesophageal junction was commonly approached surgically through a thoracoabdominal incision. With the advent of improved retraction devices, this has been abandoned because the upper midline incision has provided adequate exposure with decreased morbidity. However, exposure of the gastroesophageal junction remains a challenge in the setting of surgical complications associated with repeat surgeries and abscess formation.MethodsPatients were placed in the right lateral decubitus position. An incision was made 2 cm below the tip of the scapula to a point in the midline equidistant from the xiphoid process to the umbilicus. The chest was entered at the eighth intercostal space. The abdominal cavity was entered by dividing the diaphragm peripherally from its lateral attachments to the ribs.ResultsWe have used this approach on 4 patients. All patients were discharged home tolerating oral diets. The average postoperative stay was 10 days. No complications related to the incision were reported. At the 6-month follow-up evaluation all patients continued to tolerate a regular diet without difficulties.ConclusionsThe technique described allows for excellent exposure of the upper gastrointestinal tract in a subset of patients with complex upper gastrointestinal complications.