OESOPHAGOTOMY

OESOPHAGOTOMY
▪Incision on the esophagus for any purpose is
called Oesophagotomy.
Oesophagus:
Oesophagus is divided into three parts:
▪ Cervical
▪Thoracic
▪Abdominal
 ESOPHAGEAL ANATOMY
▪Length:
Horse: 125-150 cm
Cattle: 90-105 cm

▪Cattle esophagus is more shorter , wider

and dilatable than horse.
 ESOPHAGEAL ANATOMY
▪ Esophageal Wall:

It has 4 coats
1. Tunica Adventitia
2. Tunica Muscularis
3. Tunica Submucosa
4. Tunica Mucosa
 ESOPHAGEAL ANATOMY
▪Esophageal Sphincters:
1. Cranial Esophageal Sphincter
Formed by cricopharyngeal muscle which
arises from lateral part of arch of cricoid cartilage
and ends at raphe.

2. Caudal Esophageal Sphincter

Present at cardiac end of stomach and prevents
vomiting in response to increase gastric pressure.
 BLOOD AND NERVE SUPPLY
▪ Blood Supply:
1. Carotid Artery
2. Esophageal branch of gastric artery
▪ Nerve Supply:
1. Vagus nerve
2. Glosso-pharyngeal nerve
3. Sympathetic nerve
 ETIOLOGY
▪ To excise the esophageal neoplasm.
▪ To remove any foreign body lodged inside the
esophagus (Choking).
▪ To dissect the oesophagous in case of stenosis ,
stricture and adhesions with jugular phlebitis.
▪ To rectify the various conditions of oesophagous
like esophageal rupture, Esophageal perforation,
laceration, fistula and Esophageal diverticulum.
▪ To feed the animal in case of tetanus or pharyngeal
paralysis
 SURGICAL INSTRUMENTS
▪ Scalpel Handle and blade
▪ Surgical Gloves
▪ Surgical Mask
▪ Needle holder
▪ Non-absorable suture material
▪ Needle
▪ Hand-held abdominal retractor
▪ Tissue forceps
▪ Mayo scissors
▪ Hemostat forceps
▪ Sponge holder
 ANAESTHESIA
▪Surgical procedure is conducted with the
animal under general anesthesia.
▪This involves using a combination of
injectable anesthetics, inhalation agents,
and analgesics to induce and maintain a
deep state of unconsciousness.
 SURGICAL TECHNIQUES
1. The patient is placed in dorsal recumbency and
skin of ventral surface of neck is prepared and
draped for aseptic surgery.
2. A 10 cm long incision is made on skin and
subcutaneous tissue by scalpel blade.
3. The paired muscle of sterno-thyroid, sternohyoid
and omohyoid are separated along midline
toexpose the trachea.
4. The left carotid sheath having carotid artery and
vagus nerve should be retracted laterally.
Abdominal retractors aid in exposing esophagus.
 SURGICAL TECHNIQUES
5. Blunt separation of fascia along the left side of
trachea allows the identification of oesophagous
containing stomach tube and gentle sharp
dissection of overlying loose adventitia expose the
ventral wall of oesophagous which can be incised in
longitudinal Faison sharply through all layers

6. After the correction of anomaly esophagus

incision is closed in two layers with absorbable
suture material.Mucosal and Sub mucosal layer in
simple continuous pattern with knots tied inward.
 SURGICAL TECHNIQUES
7. Esophageal musculature can be closed with
simple interrupted pattern keeping knots
upward.
8. Finally, skin incision is closed with non-
absorbable suture material in simple
interrupted pattern and a polyethylene drain
of ¼ inch diameter is placed beside the
esophagus by a stab wound to remove serum
and blood from surgical site.
 SURGICAL TECHNIQUES
▪Approach to the Cranial Thoracic Esophagus via a
Lateral Intercostal Thoracotomy:
▪ Position the patient in right lateral recumbency
over a rolled towel placed perpendicular to the
long axis of the body.
▪Choose the appropriate intercostal space incision
based on the radiographic location of the
abnormality.
▪ Most abnormalities cranial to the base of the heart
can be accessed through an incision in the left
third or fourth intercostal space.
 SURGICAL TECHNIQUES
▪ Identify the esophagus in the mediastinum dorsal
to the brachiocephalic trunk.
▪ Identification may be aided by passage of a
stomach tube or by palpating the abnormality.
▪ Dissect the mediastinal pleura overlapping the
esophagus to just above and below the proposed
surgical site.
▪ Preserve the branch of the internal thoracic vein
and the costocervical vein, which cross the cranial
esophagus.
 SURGICAL TECHNIQUES
▪Approach to the Esophagus at the Heart Base
via a Right Lateral Thoracotomy

▪ The approach is the same as that for the cranial

esophagus except that the incision is made
through the right fourth or fifth intercostal space.
▪ Identify the esophagus, located just dorsal to the
trachea in the mediastinum.
 Surgical Techniques

▪ Dissect and retract the azygos vein from

the esophagus to allow adequate
exposure.
▪ Ligate the azygos vein if necessary to
adequately expose the esophagus.
▪Closure is the same as for cranial
thoracotomy.
 SURGICAL TECHNIQUES
▪ Approach to the Caudal Esophagus via a Caudal Lateral
Thoracotomy:

▪ Position the patient in lateral recumbency as

described above for cranial lateral thoracotomy.
▪ Perform a caudal lateral thoracotomy. Although
the caudal esophagus can be approachedthrough
an incision in either the left or right eighth or ninth
intercostal space, the left ninth space is preferred.
 SURGICAL TECHNIQUES
▪Expose the caudal esophagus by transecting
the pulmonary ligament and packing the
caudal lung lobes cranially.
▪Identify the esophagus, which is just ventral
to the aorta.
▪ Identify the dorsal and ventral vagal nerve
branches on the lateral aspect of the
esophagus and protect them.
 CONSIDERATIONS
1. Check hemorrhage during surgery
2. During dissesction prevent damage to
recurrent laryngeal nerve
3. Check if esophagus is empty it is
recognized by passing stomach tube
 CONSIDERATIONS
▪Suturing only esophagus and leaving the skin
wound open is the procedure of choice
because
1. It favours early closure of esophagus
wound
2. It prevents escape of ailmentary matter
during swallowing
3. It permits drainage of any material, if
present
 POST-OPERATIVE CARE
▪ Feed should be withheld for 48 hours.
▪ Parenteral administration of electrolyte
solution, antibiotics and anti-inflammatory
drugs.
▪Most Oesophagotomy incision heals by first
intention and intraluminal suture will slough
into lumen within 60 days.
 POST-COMPLICATIONS

▪Dehydration
▪Dilation and diverticulum
▪Dehiscence and it’s contributing factors:
1. Lack of serosa
2. Inadequate blood supply
3. Esophageal movement
4. Asepsis
 POST-COMPLICATIONS
▪Pleuritis due to aspiration pneumonia
▪Esophageal infection
▪Esophageal stricture
▪Esophageal fistula
▪Laryngeal hemiplagia due to damage of
recurrent laryngeal nerve
▪Extension in surrounding tissue
Presented by:

▪ Syed Mawaddat Ali 2021-dvm-098

▪ Muhammad Abdullah. 2021-dvm-100
▪ Abdul Wahid Zia 2021-dvm-101
▪ Muhammad Zamad-ur-rehman 2021-dvm-102
▪ Muhammad Rawal Khan 2021-dvm-104