43117 Partial esophagectomy, distal two-thirds, with thoracotomy and separate abdominal incision, with or without proximal gastrectomy; with thoracic esophagogastrostomy, with or without pyloroplasty (Ivor Lewis)

Name of the Procedure:

Partial esophagectomy, distal two-thirds, with thoracotomy and separate abdominal incision, with or without proximal gastrectomy; with thoracic esophagogastrostomy, with or without pyloroplasty (Ivor Lewis)

Summary

A partial esophagectomy is a surgical procedure where the lower two-thirds of the esophagus is removed. The Ivor Lewis technique involves making incisions in the chest and abdomen to remove the affected part of the esophagus and then reconnecting it to the stomach. This procedure may also involve reshaping the stomach or removing part of it and may include a pyloroplasty to help stomach emptying.

Purpose

This surgery is typically performed to treat esophageal cancer or severe damage to the esophagus. The goal is to remove the diseased portion of the esophagus to prevent cancer spread, alleviate symptoms, and improve the patient's ability to swallow and eat.

Indications

• Esophageal cancer
• Barrett's esophagus with high-grade dysplasia
• Severe esophageal stricture
• Recurrent achalasia
• Esophageal perforation or trauma

Preparation

• Fasting for at least 8 hours prior to surgery.
• Preoperative imaging tests like CT scans, PET scans, or endoscopies.
• Blood tests and cardiac assessments.
• Discontinuing certain medications as advised by the physician.

Procedure Description

1. General anesthesia is administered.
2. A thoracotomy (chest incision) and an abdominal incision are made.
3. The affected portion of the esophagus is carefully removed.
4. If necessary, part of the stomach may also be removed.
5. The remaining part of the esophagus is reconnected to the stomach (esophagogastrostomy).
6. A pyloroplasty may be performed to facilitate the emptying of stomach contents into the small intestine.
7. The incisions are closed and drains or tubes may be placed to help with healing.

Duration

The procedure typically takes between 4 to 6 hours.

Setting

The surgery is performed in a hospital operating room.

Personnel

• Thoracic surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Bleeding
• Respiratory complications
• Anastomotic leak (leakage where the esophagus and stomach are joined)
• Difficulty swallowing
• Changes in voice
• Gastroesophageal reflux

Benefits

• Removal of cancerous or severely damaged tissue.
• Alleviation of swallowing difficulties.
• Potential improvement in quality of life and survival rates for esophageal cancer patients.

Recovery

• Hospital stay of approximately 7-10 days.
• Initial recovery in the Intensive Care Unit (ICU).
• Gradual return to eating and drinking.
• Pain management with medications.
• Follow-up visits for assessment and monitoring.
• Full recovery may take several weeks to months.

Alternatives

• Chemoradiotherapy
• Endoscopic mucosal resection or submucosal dissection
• Stent placement
• Palliative care for non-operable cases

Patient Experience

During the procedure, the patient will be under general anesthesia and won't feel anything. Postoperatively, patients might experience pain, managed with medication. Initial discomfort or difficulty swallowing is expected, which should improve over time. Support from medical staff will be available to help with recovery and manage any complications.