Surgical treatment; a practical treatise on the therapy of surgical diseases for the use of practitioners and students of surgery . orta may be liftedforward, and the esophagus freely exposed. By dissecting up the esophagus,and bringing it out in front of the sternomastoid muscle, the danger of in-fection is avoided. THE THORAX 463 Resection of the Thoracic Esophagus.—This operation is done for cancer.Operation cannot offer hope unless the resection is wide of the disease. Thismeans the removal of so much esophagus that anastomosis to close the gapcannot be hoped for. Therefore the steps must
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Surgical treatment; a practical treatise on the therapy of surgical diseases for the use of practitioners and students of surgery . orta may be liftedforward, and the esophagus freely exposed. By dissecting up the esophagus, and bringing it out in front of the sternomastoid muscle, the danger of in-fection is avoided. THE THORAX 463 Resection of the Thoracic Esophagus.—This operation is done for cancer.Operation cannot offer hope unless the resection is wide of the disease. Thismeans the removal of so much esophagus that anastomosis to close the gapcannot be hoped for. Therefore the steps must be (i) gastrostomy to feedthe patient, (2) esophagectomy and (3) later an external plastic operationto connect the upper segment of the esophagus with the stomach. To secure access to the esophagus, an advantageous approach is thatdevised by Schede. An axillary flap is turned up on the left side containingthe^scapula, and its attached muscles (Fig. 1135). The thorax is entered byintercostal incisions and wide separation of the ribs by means of strong re-tractors. Entrance mav be made through the seventh, eighth or anv other. Fig. 1136a.—Anterior Exposure of Thoracic Esophagus, Method of Sauerbruch.A traction suture is passed around the esophagus. intercostal space. The vagi may be discovered throughout their extent frombeneath the aortic arch down to the diaphragm. The blocking of one ofthese nerves by cocain is necessary. They can not be handled roughly. W. Meyer (Surg., Gyn. andObst., December, 1912 andFebruary, 1915) ad-visecTin cancer of the upper two-thirds of the esophagus to do the operationin two stages. Incision is to be made in the eighth left intercostal space, the esophagus divided below the growth, the ends invaginated and closed, and drainage provided. Seven or ten days later, Schedes incision is madeand the chest entered through the sixth and third intercostal spaces. Thepneumogastric nerves should be carefully dissected away; one should becocainized; the esoph