43310 Esophagoplasty (plastic repair or reconstruction), thoracic approach; without repair of tracheoesophageal fistula

Name of the Procedure:

Esophagoplasty (plastic repair or reconstruction), thoracic approach; without repair of tracheoesophageal fistula

Summary

Esophagoplasty is a surgical procedure to repair or reconstruct the esophagus. This specific version uses a thoracic approach—through the chest—and does not include the repair of any existing tracheoesophageal fistula (an abnormal connection between the trachea and the esophagus).

Purpose

This procedure aims to address structural issues of the esophagus, such as strictures, damage, or congenital anomalies. The goal is to restore normal function to the esophagus, allowing the patient to swallow and digest food more effectively.

Indications

• Severe esophageal strictures causing swallowing difficulty
• Damage to the esophagus due to trauma or disease
• Congenital anomalies of the esophagus
• Failed previous esophageal surgery

Patient criteria:

• Adequate overall health to withstand surgery
• Failure of less invasive treatments to resolve esophageal issues

Preparation

• Fasting for 6-8 hours before surgery
• Adjustments or cessation of certain medications as advised by the doctor
• Preoperative diagnostics including blood tests, imaging studies (CT scans), and endoscopy

Procedure Description

1. General anesthesia is administered.
2. The patient is positioned, and a thoracic incision is made for access to the esophagus.
3. The surgeon identifies and isolates the damaged or defective section of the esophagus.
4. Repair or reconstruction is performed using surgical techniques, which may include grafting and tissue resection.
5. The esophagus is checked for integrity, and the thoracic incision is closed.
6. Drainage tubes may be placed to prevent fluid build-up.

Tools and Technology:

• Surgical scalpel
• Sutures or surgical staples
• Endoscopic instruments
• Monitoring equipment

Duration

The procedure typically takes between 3-5 hours, depending on the extent of reconstruction needed.

Setting

Esophagoplasty is performed in a hospital operating room equipped for thoracic surgery.

Personnel

• Thoracic surgeon
• Anesthesiologist
• Surgical nurses
• Scrub technician
• Anesthesia nurse

Risks and Complications

• Common: Bleeding, infection, pain
• Rare: Anesthesia complications, leakage at the repair site, aspiration pneumonia Complications are managed with medication, further surgery if necessary, and supportive care.

Benefits

• Improved ability to swallow and digest food
• Relief from associated symptoms like pain and regurgitation Benefits are generally noticeable within a few weeks post-surgery.

Recovery

• Hospital stay of 5-7 days post-surgery
• Gradual return to eating, starting with liquids and progressing to solids as tolerated
• Avoid heavy lifting and strenuous activities for at least 6 weeks
• Follow-up appointments to monitor recovery and ensure the success of the surgery

Alternatives

• Endoscopic dilation for less severe strictures
• Esophageal stenting
• Non-surgical management with dietary modifications or medications

Pros and Cons:

• Alternatives may be less invasive but may also be less effective for severe cases.

Patient Experience

Patients might experience postoperative pain managed with medication, and discomfort related to chest tubes and surgical wounds. Swallowing will progressively become easier, and follow-up care will help ensure a smooth recovery.