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Wed Sep 5 21:49:04 BST 2007

Would agree with right thoracotomy and would relly push for a primary repair. I'd be surprised if the original thoracotomy was done in the 4th ICS and would probably use the same skin incision and just go up an interspace to find a nice fresh intercostal pedicle. 

  Kai

KMATTOX at aol.com wrote:

In a message dated 9/4/2007 3:43:39 P.M. Central Daylight Time, 
mgreeds at reeds.uk.com writes:

1) a resection and primary anastomosis (with numerous drains - in case
of a subsequent anastomotic leak/breakdown);

2) bringing out the "leak" through the chest as a T-tube; or,

3) oesophagostomy

I would be keen to hear others' views on this list regarding which procedure
they would perform (I am sure that there are people who sit STRONGLY in each
of the respective camps!)

It depends on the amount of contamination, and I could support each. If I 
did an esophagostomy (cervical), I would ADD a draining gastrostomy and a 
feeding jejunostomy. 

One other BIG point. As I entered the chest, I would prepare a 4ICS 
intercostal muscle flap, to WRAP the esophageal repair with upon completion of the 
procedure. At this juncture, however, this possibliity is probably 
"trashed" by the first operation, with vascular compromise of the potential muscle 
pedicle. I have always prepared such a muscle flap any time I go into the 
chest with a potential esophageal injury. 

k mattox

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