Diverticulectomy of hypopharynx or esophagus, with or without myotomy; thoracic approach
CPT4 code
Name of the Procedure:
Diverticulectomy of Hypopharynx or Esophagus, with or without Myotomy; Thoracic Approach
Summary
A diverticulectomy is a surgical procedure to remove an abnormal pouch (diverticulum) located in the hypopharynx (lower throat) or esophagus. This specific procedure is performed through the chest (thoracic approach). It may also involve cutting a muscle (myotomy) to prevent recurrence or improve swallowing.
Purpose
The procedure addresses conditions where a diverticulum causes difficulty swallowing, regurgitation of food, or aspiration (food entering the lungs). The goals are to alleviate symptoms, improve swallowing, and prevent complications such as aspiration pneumonia.
Indications
- Difficulty swallowing (dysphagia)
- Regurgitation of undigested food
- Chronic cough or recurrent respiratory infections
- Aspiration pneumonia
- Presence of a confirmed diverticulum in the hypopharynx or esophagus through imaging studies
Preparation
- Fasting for at least 6-8 hours before the procedure.
- Temporary cessation or adjustment of medications as instructed by the healthcare provider.
- Preoperative imaging studies like barium swallow or esophagoscopy to map out the diverticulum.
- Blood tests and possibly a chest X-ray or ECG to evaluate overall health.
Procedure Description
- The patient is placed under general anesthesia.
- A thoracic surgeon makes an incision in the chest to access the esophagus.
- The diverticulum is identified and carefully removed.
- If necessary, a portion of the esophageal muscle is cut (myotomy) to improve swallowing function.
- The esophagus is then repaired and the chest incision is closed.
- A drainage tube may be temporarily placed to prevent fluid buildup.
Specialized surgical tools are used, and modern techniques often involve minimally invasive methods with the help of thoracoscopic instruments.
Duration
The procedure typically takes 2-3 hours, but this can vary based on the complexity of the case.
Setting
The procedure is usually performed in a hospital operating room.
Personnel
- Thoracic surgeon
- Anesthesiologist
- Surgical nurses
- Operating room technicians
Risks and Complications
- Infection
- Bleeding
- Injury to surrounding structures (e.g., nerves, blood vessels)
- Leakage from the esophagus at the surgical site
- Postoperative pain
- Respiratory complications
- Rare risks include recurrence of symptoms and need for additional surgery
Benefits
- Alleviation of swallowing difficulties
- Reduction in regurgitation and aspiration incidents
- Improvement in overall quality of life
Patients often begin to notice the benefits within days to weeks after the surgery.
Recovery
- Hospital stay of 3-5 days post-surgery.
- Pain management with medications.
- Gradual reintroduction of oral intake, starting with liquids and progressing to soft foods.
- Follow-up appointments for monitoring recovery and possible imaging studies to ensure proper healing.
- Avoidance of strenuous activities for at least 4-6 weeks.
Alternatives
- Observation and dietary modifications for mild cases.
- Endoscopic treatments (less invasive but may be less effective for larger diverticula).
- Botox injections to temporarily relieve symptoms (non-surgical but may need repeating).
Each alternative has its own set of risks and benefits which should be discussed with a healthcare provider.
Patient Experience
The patient will be under general anesthesia during the procedure, thus will not feel anything. Post-procedure, there may be pain and discomfort in the chest area which is managed with pain medications. Swallowing might be uncomfortable initially, but improves as healing progresses. Regular monitoring and gradual diet changes are part of the recovery process, with full recovery generally expected within 4-6 weeks.