By William H. ReMine M.D.,M.S. (Surg.) D.Sc.(Hon), W. Spencer Payne M.D.,M.S., Jon A. van Heerden M.B., Ch.B. (Cape Town) F.R.C.S. (C) (auth.)
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Extra resources for Manual of Upper Gastrointestinal Surgery
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1-54).
Esophageal retention and stasis may evoke subjective heartburn and even inflammation and ulceration in the distal esophagus that are clinically and morphologically indistinguishable from those of gastroesophageal reflux. Despite an intact pharyngeal mechanism and a normal upper esophageal sphincter, spontaneous and postural regurgitation of esophageal contents into the pharynx, mouth, or nose frequently occurs. This material is characteristically bland, undigested, "fresh" food that is retained in the esoph- 51 The Esophagus and Esophagogastric Junction agus.
Persistent or recurrent attempts at forceful dilatation may result in hemorrhage and fibrosis in the esophageal wall, which can preclude the performance of an effective operation by fusing the dissection plane between the esophageal muscularis and mucosa. Technique. A left thoracotomy provides exposure. The pleural space is entered through the bed of the unresected eighth rib. The inferior pulmonary ligament is divided, and the lung is retracted cephalad. The dome of the left diaphragm is retracted caudad.