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

What is the recommended procedure for an esophageal injury in the upper 2/3 of the esophagus?

1. Neck - left side approach

2. Right thoracotomy, avoid the aorta

3. Left thoracotomy

4. Endoscopic repair

The correct answer is: Right thoracotomy, avoid the aorta

An esophageal injury in the upper two-thirds of the esophagus typically requires careful surgical intervention due to the proximity to important structures like the aorta and trachea. The recommended approach for repair in cases of esophageal injury, especially in the upper section, is a right thoracotomy. This method allows for adequate exposure of the esophagus while minimizing the risk of damaging vascular structures, specifically avoiding the aorta, which runs posterior to the esophagus in this area. The right thoracotomy provides the surgeon with the necessary access to control bleeding, assess the extent of the injury, and perform a direct repair of the esophagus if needed. The right-sided approach also allows for better visualization of the upper esophagus compared to other approaches, further facilitating effective and safe management of the injury. In contrast, while other approaches like a left-sided neck approach or endoscopic repair may be considered, they are not ideal for significant injuries in the upper two-thirds of the esophagus due to limited access or inadequate exposure.