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Esophagectomy: Understanding The Procedure

Esophagectomy is a technique where some length of the tube between the mouth and stomach (throat) is removed and reconstruction is done using part of another organ, usually the stomach.

Esophagectomy is a typical therapy for advanced esophageal cancers, and it is likewise used to treat Barrett’s esophagus if aggressive malignant cells are present. An esophagectomy might also be suggested for noncancerous conditions when earlier attempts to save the esophagus failed, which include with end-stage achalasia or strictures, or after ingestion of material that damages the lining of the esophagus.

How is The Procedure Conducted?

The term esophagectomy does not apply to a specific operation. It can be conducted in a variety of ways. The procedure used is decided by your needs as well as the surgeon’s expertise. An open esophagectomy can also be used in association with radiation and chemotherapy to treat esophageal cancer.

Types of Esophagectomy Procedures 

The surgical approaches may include the following:

  • McKeown esophagectomy: In this procedure, incisions are made in the neck, chest as well as abdomen to remove esophagus and re-build the gastrointestinal tract.
  • Thoracoabdominal esophagectomy: In this procedure, a single incision from chest to the abdomen (on the left side) is made and an incision in the neck is made.
  • Transhiatal esophagectomy: In this method, incisions in the neck and abdomen are made, with the intervening esophagus being cut (dissected) out bluntly (with the fingers).
  • Ivor Lewis esophagectomy: In this procedure, one incision is on the right side of chest and the other in the abdomen is made.
  • Minimally invasive esophagectomy: Your surgeon may choose to perform a portion or all of the esophagectomy using minimally invasive methods. A laparoscope may be used in the abdomen, a robot may be used in the chest and/or abdomen, or a thoracoscope may be used in the chest. Laparoscope and thoracoscope are flexible, long thin instruments for examining the abdomen and chest. When minimally invasive modules are mixed with more traditional (open) modules, the procedure is known as a “hybrid” procedure.

Preparation of Esophagectomy

Your doctor and team will talk to you about any questions you may have about the surgery. If you have cancer, your doctor can prescribe chemotherapy, radiation, or both before an esophagectomy, followed by a period of recovery. These decisions will be made depending on the stage of your cancer, which must be determined before any discussion of treatment before surgery.

If you smoke, your doctor will advise you to avoid and may prescribe a cessation program to assist you in doing so, as smoking significantly increases the risk of complications following surgery.

Precautions to Take After the Procedure

Tube feeding (enteral nutrition) is a procedure in which a narrow tube is inserted into your abdomen and connected to your small intestine. This method of feeding will last for four to six weeks to ensure that you get enough nutrition while recovering. Because of the smaller stomach, you will need to eat more often and in smaller amounts once you resume a regular diet. Following surgery, you can lose weight. 

What is the Need for an Esophagectomy?

An esophagectomy is regularly used to prevent spread in the early phases of esophageal cancerous growth that has not spread to the stomach or different organs. It can likewise be utilized to treat esophageal dysplasia, a precancerous condition influencing the cells that line the throat. 

Most patients who need esophagectomy are at a stage where the disease has spread to their lymph nodes, liver, or different organs. Different conditions that affect the digestion of food and fluids can essentially require an open esophagectomy as treatment. Some conditions that require  this surgery: 

  • Damaged or trauma to  Esophagus
  • Difficulties in swallowing 
  • Acid reflux
  • Persistent irritation in the digestive tract, 
  • Obstructions that keep food from passing through to the stomach, 
  • A background of failed esophageal surgery
  • swallowing of caustic, or cell-damaging, agents such as lye
  • chronic inflammation
  • complicated muscle disorders that prevent the movement of food to the stomach

If you doubt that any of the above-mentioned complications can be affecting your body, you should immediately schedule your appointment with healthcare professionals at the earliest.

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How Will The Procedure Benefit Me?

The esophagectomy will potentially be able to stop the spread of malignancy in your body; it may effectively make you cancer-free. You may also experience an improvement in your quality of life because of your disease-free condition.

What the Risks Associated with Esophagectomy?

The procedure is relatively risk-free when conducted under the supervision of an expert health team. 

Esophagectomy carries the risk of a variety of complications, including:

  • Infection and bleeding
  • Cough
  • Leakage from the esophagus-to-stomach surgical link
  • Variations in your accent
  • Reflux of acid or bile
  • Nausea, vomiting, or diarrhea
  • Complications of the lungs, such as pneumonia
  • Having trouble swallowing (dysphagia)
  • Death from atrial fibrillation in rare cases

In rare cases, the patient may be at the risk of:

  • Blood clots in the legs that could spread to the lungs
  • an injury as a result of anesthesia issues
  • breathing difficulties
  • a heart attack during surgery
  • a stroke while undergoing surgery

Frequently Asked Questions (FAQs)

Is it normal to feel tired after surgery?

Yes, it is very common to feel tired after the surgery. The recovery phase can be different for all. 

Can I do air travel after my surgery?

It is best to avoid air travel for some time directly after surgery. The rest of the instructions will be shared by your concerned doctor during the first appointment after the surgery.

When can I start lifting heavy objects?

Normally, you should not lift any heavy objects for at least 8-10 weeks. If required in case of urgency, try to lift the object that weighs less than 10 pounds (less than 5 kg). Your surgeon will be able to guide you more effectively after taking your health and recovery process into consideration. 

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