American Board of Surgery Qualifying Exam (ABS QE) Practice Test

For injuries to the lower 1/3 of the esophagus, what approach is suggested?

1. Left thoracotomy

2. Neck - right side approach

3. Right thoracotomy

4. Transabdominal approach

The correct answer is: Left thoracotomy

For injuries to the lower third of the esophagus, a left thoracotomy is generally suggested as the most appropriate surgical approach. This is primarily due to the anatomic location of the esophagus, particularly in relation to the diaphragm and the surrounding structures. The left thoracic approach provides direct access to the lower esophagus and allows for effective management of the injury. Injuries in this region may require debridement, repair, or resection, and the left thoracotomy allows surgeons to visualize and address these intrathoracic injuries more effectively. Additionally, this approach facilitates the identification and management of any associated injuries to surrounding structures, such as the aorta or the left lung. The other approaches, such as the right thoracotomy or neck - right side approach, may not provide the same level of access to the lower esophagus. A transabdominal approach, while useful in certain situations, is less favorable for direct injuries to the lower esophagus specifically, as it doesn't offer the necessary thoracic exposure for comprehensive evaluation and treatment of the injury. Thus, utilizing a left thoracotomy helps ensure optimal access and management of injuries to this part of the esophagus.