Esophagectomy is the removal of the esophagus, an extreme measure of digestive tract therapy. This method is chosen for oncological diseases and other pathologies of the esophagus, when conservative methods of treatment are ineffective. Depending on the severity of the course of the disease, the stage of development of the esophagus is removed partially or completely. The body is restored in a few months, the operated organ or its complete absence does not bring obvious discomfort, but nutrition must be reviewed. Removal of any organ is considered an extreme measure to save human health.
Description
An operation on the esophagus consists in cutting off a part of the organ (resection of the esophagus) or completely replacing it with an implant. The main premise for removal is manifested by dysfunction of individual parts of the organ. This is manifested by insufficiency of the lower section, while the gastroesophageal reflex is prevented by the outlet of the mucous membrane of the cardia.
The esophagus is an intermediate organ that transfers food from the mouth to the stomach during digestion. When removing even a small part of the esophagus, its replacement and strengthening is required. This will preserve the integrity of the digestive system. There are different methods for resection; their choice depends on the qualifications of the surgeon and the individual characteristics of the patient. When is an esophagus operation prescribed?
Indications for surgery
As already noted, surgical intervention on the esophagus is resorted to in extreme cases in the treatment of digestive system insufficiency, to ensure closure of the passage, so the indications should be serious. Resection is appointed:
- With erosive esophagitis - severe inflammation of the outlet of the mucous membrane of the cardia in the upper part. A surgical operation is appropriate if a gradual closure of the lumen occurs, and therapeutic methods have not achieved the desired result.
- Barrett's esophagus with a large change in cells. Thanks to radical methods of treatment, the patient is protected from the formation of oncology.
- Mediastinitis is an inflammation in the middle area of the sternum caused by a large foreign body in the esophagus. It presses on the walls, the passage closes.
- Mechanical, chemical damage to the organ, narrowing. If you do not conduct timely surgical intervention, it will be quite difficult to maintain the closure of the passage, and the consequences will manifest in acute failure of the lungs, liver, kidneys, stomach.
- Esophageal hernia. The operation is carried out quite often.
- Cancer If a malignant tumor has developed, this requires a partial or complete removal of the esophagus. The degree of development of the oncological process affects this. In cancer, the main step in the treatment will be esophagectomy.
How to identify the need for surgery on the esophagus?
The main symptoms can not be a significant reason for surgery, for the operation you need a specific diagnosis, based on which, the doctor will determine the need for radical measures.
A thorough examination is required to clarify the diagnosis, especially if a tumor of the esophagus is suspected (surgery in this case should be immediate). Diagnostics includes:
- esophagus fluorography - an increase in the lumen of the esophagus, restructuring of the mucosal relief, shape and their unevenness are detected;
- esophagomanometry - determine the displacement of the cardia in the posterior mediastinum (such as cardia failure);
- endoscopy;
- biopsy
- analysis of tumor markers;
- endoscopic optical coherence tomography.
How to prepare for the procedure?
A serious burden on the body will be any surgical intervention. It is important to adhere to preoperative recommendations so that negative consequences do not occur:
- you need to keep under control and supervision of a doctor high blood pressure, diabetes, pathologies in the stomach, heart failure;
- follow all nutritional recommendations;
- in no case take medications to thin the blood — vitamin E, aspirin;
- do not take medications that reduce muscle tone, as they affect the cardiac sphincter;
- it is necessary to refrain from smoking a month before surgery on the esophagus - nicotine dramatically increases pressure and leads to malfunctions in the respiratory system. You need to be prepared to take tests for the presence of nicotine in the blood.
Surgical intervention
The procedure completely depends on the individual characteristics of the patient and on certain signs and symptoms. Surgical intervention takes place in several stages - anesthesia, surgery, postoperative recovery period.
During surgery, they use general anesthesia. With its help, the patient is put into a state of sleep during the intervention and all pain is blocked. To support the respiratory process, a special tube is placed in the trachea.
Resection of the esophagus lasts an average of six hours. Various complications during the surgical procedure, concomitant illnesses and the severity of the disease can prolong this time. In addition, the time of the operation depends on whether the organ is completely removed or partially. What happens after an operation to remove a hernia of the esophagus? About it - further.
Types of Interventions
Operational methods are divided into several types. They make up two groups. May be radical and palliative.
Radical completely eliminates the affected areas. There are several ways of such surgical interventions:
- Extirpation of the esophagus refers to its complete removal. It will be appropriate for cancer, Barrett's disease or overall scarring.
- Resection is a partial removal of the esophagus. This is facilitated by cancer, which has affected a separate part of the organ, while it gradually closes; cicatricial narrowing and inflammation of the outlet of the mucous membrane of the cardia; esophageal hernia. The operation is of two types, can be immediate or secondary.
- Lewis technology is called partial excision with the instant replacement of part of the esophagus with a tube that is made from gastric tissues.
- The tunnel method of esophageal extirpation is considered an operation that is performed through two incisions in the epigastrium and on the neck, a gaping passage is formed under the skin that connects them.
Palliative operative methods
Necessary to maintain the functions of the esophagus, as well as to improve the well-being of the patient. They are divided into several types:
- Gastrostomy is applied: if the esophagoplasty cannot be resected, then a gastric fistula for nutrition is inserted into the patient, bypassing the esophagus.
- Stenting is performed: a special tube is inserted into the esophagus to ensure that the passage is not closed.
- Provide sclerosis of the veins in the esophagus: often necessary for cirrhosis. Use substances that wrinkle veins - ethoxysclerol or medical acrylic glue. Until then, the substances are introduced until the veins are completely sclerosed.
- Ligation of varicose veins is performed - this procedure resembles the previous method, but the duration is much longer.
In addition to the main types, several separate operational methods are distinguished.
Complete removal
To perform such an operation, the chest cavity is fully opened. The postoperative prognosis will be mostly unfavorable, such therapy is prescribed only for severe forms of esophageal pathology. In this case, the organ is replaced with an implant made of gastric tissue. This can be done immediately or during repeated surgery.
The latest minimally invasive technology does less damage, it is longer, but has a good prognosis.
Therefore, it is more desirable as an alternative to treatment. A tunnel is made under the skin, they penetrate inside with medical instruments, and then it easily grows together. The esophagus is cut off through the upper and lower incisions, then it is removed through the subcutaneous passage.
Resection
Indications for resection of the esophagus are Barrett's disease, cardiospasm, an enlarged esophagus in a baby at birth. In this procedure, the organ in a person is partially removed, then its subsequent instant replacement is performed - they are operated according to the Lewis method.
Laparoscopic surgery
With pathologies in the lower parts of the esophagus and upper esophageal opening in the diaphragm, as well as dysfunction of the outlet of the mucous membrane of the cardia, this type of operation of the esophagus is prescribed. Treatment in this case will be more effective. So sewn and strengthen post-hernia openings, reduce the volume of the stomach, make the plastic organ, namely the lower cardiac section.
The implementation of endoscopic manipulations
This method is used to remove benign tumors on the mucous membrane, polyps.
This requires ligation of varicose venous vessels, sclerotherapy, laser irradiation, cauterization or exposure to low temperatures on the affected areas.
The main instrument is an endoscopic probe. On it is a mini-video camera, a combination of magnifying lenses and lighting devices. The necessary instruments are introduced into the lumen of the esophagoscope.
What risks and complications can this lead to?
The doctor should warn the patient that the procedure can lead to various negative complications:
- thrombosis;
- bleeding
- infection;
- heart failure during surgery;
- an allergic reaction to anesthesia;
- respiratory failure.
With open resection of the esophagus, there is a lower risk of complications such as:
- lung lesions;
- infection in the chest cavity;
- surgical damage to neighboring organs;
- gradual closure of the passage between the esophagus and stomach.
The period after the operation to remove the esophagus
The first week the patient feels weakened, he cannot take food on his own. The feeding tube helps. For about two weeks, the doctors look after the patient so that possible leaks in the operated area do not occur.
If they are not found, the diet is gradually diluted - soft and then solid foods are added to the nutrient fluids. Between meals, breathing exercises are shown by the method of deep breathing, restoring the tone of the cardiac sphincter. The patient is supplied with a stimulus spirometer, so the load is monitored and gradually increased.
Possibility of dumping syndrome
In simple words, the intestines reject food. This is due to gastric insufficiency, loss of ability to independently digest fats and sugar. Muscle cramps with the main symptom, diarrhea, lead to dumping syndrome. Symptom management, nutritional management. Six months are enough for a complete restructuring of the body, the stomach will be able to adapt to a new lifestyle. Nutrition after esophageal surgery is of utmost importance.
Diet
Some time after surgery, nutrients are injected directly into the stomach. Before returning to normal nutrition, the operated organ must be prepared. A transparent liquid with the necessary content of substances is introduced into the stomach to maintain vital activity. They do not require a lot of secretion. After two weeks, the digestive system is strengthened, soft food is gradually introduced into the diet, and over time - more solid.
Due to the small size of the stomach, the portions should be small. An important part of postoperative recovery is diet. They select it individually and according to such a principle that it resembles a diet after a gastrectomy. Operations for cancer of the esophagus and stomach are very similar.
The main point of the diet will be to avoid unprocessed, rough, annoying food. It should be more liquid, portions should be small, and receptions frequent. A diet is prescribed depending on the individual characteristics of the patient. What can an operation to remove the esophagus result in?
Forecast
The percentage of positive dynamics of recovery is quite large. Medicine is at a high level in surgical intervention. Recently, the number of deaths has been reduced, and the risk of complications is minimized by high-precision technologies and tools. After a few months, the patient can return to normal diet, following a diet.
Here's how esophageal hernia surgery is performed (reviews confirm this), as well as other pathologies.
Reviews
Reviews about the operation on the esophagus are mostly good. Positive dynamics are noted, complications are rare. Especially often the esophagus is operated on for a hernia. It is quite difficult to keep a diet, but over time, the diet expands and becomes diverse.