Background. Because of the transient nature of pharyngeal phase dysphagia, posttranshiatal esophagectomy patients provide a model for studying the correlation of dysphagic symptoms and aspiration with deglutitive biomechanics. Methods. We studied 8 transhiatal esophagectomy patients (age range, 51 to 78 years) and 8 normal age-matched controls in upright position using lateral and anteroposterior (AP) projection videofluoroscopy during three 5 mL barium swallows. Results. The maximum upper esophageal sphincter (UES) AP diameter and maximum anterior excursion of the hyoid bone in patients with transhiatal esophagectomy who experienced aspiration (6.2 ± 0.6 and 9.0 ± 2.0 mm, respectively) were significantly smaller than those of age-matched normal controls (9.4 ± 0.7 and 17.0 ± 1.0 mm, respectively). Resolution of aspiration was associated with a significant increase in AP diameter of the UPS as well as anterior and superior excursion of the hyoid bone (p < 0.05). Conclusions. Dysphagic symptoms and aspiration in posttranshiatal esophagectomy patients are associated with significant abnormalities of deglutitive-biomechanics. Improvement in deglutitive biomechanics is associated with resolution of dysphagic symptoms as well as postdeglutitive aspiration in these patients. (C) 2000 by The Society of Thoracic Surgeons.