Mediastinotomy Extrapleural Posterior

Extrapleural posterior mediastinotomy (m. extrapleuralis posterior) is a surgical operation in which extrapleural access from the rear is used to access the structures of the posterior mediastinum.

To access the posterior mediastinum, an incision is made parallel to the spine between the ribs and scapula. The back muscles are separated from the ribs and vertebrae without damaging the adjacent pleura. This creates an extrapleural space through which you can access the esophagus, azygos and semi-gypsy veins, and lymph nodes of the posterior mediastinum.

This operation can be used to remove mediastinal tumors, restore patency of the esophagus, and lymphadenectomy. It allows you to perform the necessary intervention without opening the pleural cavity.

Mediastinotomy is an operation that involves exposure, revision and treatment of mediastinal organs through access to them from the posterior mediastinal space between the sternum (ribs) and the spine. The organs of the posterior mediastinum include the pericardium, esophagus, cervical trachea (below the level of the cricoid cartilage) and adjacent organs (thoracic aorta, vagus nerve and branches).

After opening the posterior mediastinum, the patient is usually transferred to the operating table and the cutting off of the posterior mediastinal vault begins. Then, guided by the topographic landmarks of the posterior surface of the sternum, ribs and vertebrae, the peritoneum is peeled down from the medial (end) plate of the anterior surface of the posterior wall of the pleural cavity. To expose the root of the lung, bluntly cut layer by layer of the parietal pleura. The root of the lung and the phrenic nerve are removed. After exposing the posterior organ of the lateral mediastinum, it is examined, the condition of the tissue, veins, and lymph nodes is noted. The incision is made along the line of attachment regarding the scar on the esophagus. Mediastinitis at the site of the skin incision appears after 24 hours through the appearance of lymph and the development of an inflammatory infiltrate, which often resemble lymphoma. Typically, mediastinitis is well recognized within a day.

Direction of operation: Snake-shaped (downwards towards the VIII thoracic vertebra to the right), Tracheoesophageal drains remain in the surgical wound; Subcutaneous drainage. The esophagus was separated from the trachea, the diaphragms were removed. Sclerosis of the phrenic artery. There is no preoperative preparation.