The cervical esophagogastrostomy is performed through a neck incision. An upper midline laparotomy incision is performed after the patient has been anaesthetized and the abdomen prepped. The incision is then carried into the xiphoid down to the umbilicus. The left neck is prepped as well with a small roll placed behind the shoulders and neck to hyperextend the neck turning the head upward and to the right. After a thorough abdominal exploration, the left triangular ligament of the left lobe of the liver is taken down and the liver was retracted out of the way.
Exposure is aided by a upper bilateral costal self-retaining retractor.
The greater omentum is taken down away from the right and left gastroepiploic arteries approximately 2.5 cm. This continues it to the short gastrics, attaching the stomach from the gastrosplenic ligament. Adhesions in the lesser sack are also ligated. The lesser omentum is taken down preserving if possible the right gastric artery. A generous Kochler maneuver attaching the second, third, and forth portions of the abdomen from its retroperitoneal attachments.