Esophagectomy

Esophagectomy is a surgical operation where the swallowing tube (esophagus) between your mouth and stomach is partially or completely removed and then rebuilt using tissue from another organ, typically the stomach.

Why is Esophagectomy surgery done?

The primary surgical remedy for esophageal cancer is esophagectomy. Either the malignancy is eradicated or the symptoms are alleviated. If aggressive precancerous cells are present, esophagectomy is occasionally used to treat Barrett’s esophagus in addition to being a common therapy for advanced esophageal cancer. When other attempts to salvage the esophagus have failed, such as with end-stage achalasia or strictures, or after ingesting anything that harms the esophageal lining, an esophagectomy could be advised for noncancerous diseases.

How is the surgery Performed?

An incision is made in the neck, chest, or belly during an open esophagectomy, during which the surgeon removes all or part of the esophagus. In most cases. the esophagus is replaced with another organ, usually the stomach although on occasion the small or large intestine may also used to replace the esophagus.

Esophagectomy may often be performed minimally invasively using laparoscopy, robot assistance, or a combination of these techniques. These operations, which are carried out through a series of tiny incisions when necessary, can be less painful and have a quicker recovery time than traditional surgery.

Types Of Esophagectomy 

• McKeown Esophagectomy or Open Esophagectomy – During an open esophagectomy, one or more significant incisions are made in the neck, chest, or belly and rebuild the gastrointestinal tract. A transthoracic esophagectomy, which involves making incisions in the chest and belly to remove the esophagus, is an option for the surgeon. Alternately, the doctor might conduct a transhiatal esophagectomy, which involves making incisions in the neck and belly. Occasionally, a three-field esophagectomy is required, which involves making incisions in the neck, chest, and abdomen.
• Thoracoabdominal Esophagectomy – In this process, on the left side, a single incision is created that extends from the chest to the belly, as well as a neck incision.
• Transhiatal Esophagectomy – Cuts are made in the neck and belly, and the esophagus in between is severely dissected out (with the fingers).
• Ivor Lewis Esophagectomy – The right side of the chest has one incision, and the abdomen has another.
• Minimally Invasive Esophagectomy – This method entails removing the esophagus by several tiny incisions in the chest or the belly (laparoscopically) (thoracoscopically). The thoracoscope and laparoscope are two long, slender, flexible tools used for chest and abdominal examination. In laparoscopic surgery, the surgeon makes small incisions and inserts tools and a camera-tipped device to examine and carry out the procedure without severing any muscles or breaking any ribs. This technique could be aided by a robot in some hospitals.

Post Surgery 

No matter what kind of esophagectomy is performed, the patient is transported to the intensive care unit (ICU) for 24-48 hours following surgical esophagectomy. The epidural will be modified to provide the best possible pain relief when the patient is weaned off the ventilator and transitioned to tube feedings with the help of a jejunostomy tube (feeding tube) which is inserted as part of the procedure. As the patient regains the ability to swallow, this is utilized to deliver nutrients for up to 30 days following surgery.

A nasogastric tube, a drain that enters via the nose, will also be present in the patient. This tube is necessary to maintain the stomach’s decompression so that the newly formed link between the esophagus and the stomach has a greater chance of healing.