Q) Trans Hiatal Esophagectomy (THE) vs Trans Thoracic Esophagectomy (TTE) – which is not true?
(Question asked in all AIIMS and INI exams since 2017)
a) Leak rates are more with TTE
b) Pulmonary complication is more with TTE
c) Side to side stapler anastomosis has less leaks than open two layer suturing
d) THE can be done through minimally invasive surgery
Answer: c
Pulmonary complications are 57% with TTE and 27% with THE (SKF 409).
Anastomotic leak: 16% in TTE vs 14% in THE (not significant).
Subclinical leak is slightly more in THE.
Option D is correct — THE can be done via minimally invasive approach.
Blackmon et al. published a propensity-matched analysis comparing outcomes between side-to-side stapled, end-to-end circular stapled, and handsewn — with no significant difference in leak rates. (SKF page 475)
Cardiac complications, Vocal cord palsy, Wound infection, Chyle leak are all more with TTE.
