What are the indications of esophagectomy?

Esophagectomy is a procedure performed by a General Surgeon in Lahore for a number of esophageal disorders, but particularly for tumors of the esophagus. Read on to know more about the types of esophagectomy and the indications for it:

What is esophagectomy?

The surgical procedure for the removal of the esophagus—the gut tube connecting the mouth and stomach—followed by reconstruction, is called esophagectomy. This procedure is commonly performed for treatment of advanced esophageal cancer and pre-malignant conditions like Barrett’s esophagus.

Non-malignant conditions involving esophagectomy include: end-stage achalasia and ingestion of caustic fluid causing damage to the esophagus or stricture formation.

What are the types of esophagectomy?

The three types of esophagectomy procedures are:

  • Transthoracic esophagectomy (TTE): this type of esophagectomy is performed through chest incision. TTE is preferred when parts of the esophagus, as well as, stomach need to be removed. Following the resection, remaining parts of the esophagus and stomach are connected through parts of colon. In this procedure, the involved lymph nodes of neck and chest are also removed.

The indications of transthoracic esophagectomy include:

  • Cancer of the esophagus (upper part)
  • Complications of esophagitis—inflammation of the esophagus
  • Barrett’s esophagus with a lot of metaplasia
  • Damage to the esophagus due to caustic agent
  • En bloc esophagectomy: this is a radical esophagectomy procedure with removal of the whole of the esophagus, part of the stomach, and abdominal plus thoracic lymph nodes. Following this procedure, the remaining part of the stomach is brought up to the neck to replace the esophagus.

The indication of en bloc esophagectomy is:

  • Localized tumor of the esophagus
  • Trans-hiatal esophagectomy (THE): this is a minimally invasive surgery involving removal of the esophagus through two small incisions: one at the left side of the neck, and the other at the abdomen, from the bottom of the breastbone to the bellybutton. From these incisions, the esophagus is removed without an incision on the chest.

After removal of the esophagus, the involved lymph nodes in the neck or chest are also removed, as with TTE. Thereafter, the stomach is moved up to the neck.

The indications of trans-hiatal esophagectomy include:

  • Esophageal cancers
  • Tightening or narrowing of esophagus
  • Repair of lower esophageal sphincter for gastroesophageal reflux disease (GERD)
  • Correction of nervous system disorders involving esophagus
  • Repair of esophageal injury secondary to caustic agent

What are the complications of esophagectomy?

The complications of this procedure are:

  • Pleural effusion
  • Atelectasis in 3 percent cases
  • Leak of the anastomotic site especially after tumor resection
  • Pneumonia
  • Chylothorax or leakage of lymphatic fluid but it is a rare complication
  • Wound infection
  • Injury to the trachea
  • Paralysis of the recurrent laryngeal nerve causing change in voice
  • Abdominal or intrathoracic bleeding
  • Dysphagia or pain on swallowing
  • Acid reflux
  • Bile reflux
  • Atrial fibrillation
  • Death

What to expect after esophagectomy?

After the surgery, the patient should wake up to expect:

  • Nasogastric tube: in place to decompress the stomach and remove stomach fluids.
  • Chest tube: to drain fluids from the region of surgery
  • Feeding jejunostomy tube: to provide nutrition to the patient by-passing the stomach. This stays in place until the patient can feed on their own and the stomach wounds heal.
  • Foley’s catheter: to drain urine for the first few days after surgery

What are the contraindications of esophagectomy?

Esophagectomy should not be performed in the following conditions:

  • Stage IV disease: patients with cancer which are on stage IV, with metastases to the liver, lung pleura or abdomen should not get esophagectomy.
  • Co-morbidities: patients with heart or lung disease which prohibit surgery should not undergo esophagectomy.

When to seek help after esophagectomy?

Following the surgery immediate medical help should be sought from Best General Surgeon in Rawalpindi if there is:

  • Pain at the operative site
  • Dark stools
  • Bleeding or redness at the wound site
  • Burning feeling in the throat
  • Fever
  • Jaundice
  • Persistent cough
  • Feeling weak
  • Shortness of breath

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