43341 Esophagojejunostomy (without total gastrectomy); thoracic approach

Name of the Procedure:

Esophagojejunostomy (without total gastrectomy); thoracic approach

Summary

An esophagojejunostomy with a thoracic approach is a surgical procedure that connects the esophagus directly to the jejunum (a part of the small intestine) through an incision in the chest. This bypasses the stomach without removing it, allowing food to move from the esophagus to the small intestine.

Purpose

This procedure is typically performed to treat issues such as severe stomach or esophageal diseases, like cancer or motility disorders, which hinder normal functioning. The goal of the surgery is to restore the patient's ability to eat and digest food more normally and comfortably.

Indications

• Esophageal cancer or tumors that obstruct normal food passage.
• Severe motility disorders affecting the stomach or esophagus.
• Non-malignant strictures or blockages in the esophagus.
• Prior surgeries that have failed to alleviate the condition.

Preparation

• Patients may need to fast for at least 8 hours prior to the procedure.
• Certain medications may need to be paused or adjusted.
• Preoperative tests may include blood work, imaging studies like CT scans, and an esophagogastroduodenoscopy (EGD).

Procedure Description

1. The patient is given general anesthesia.
2. A thoracic surgeon makes an incision in the chest to access the esophagus and jejunum.
3. The surgeon disconnects part of the esophagus and reconnects it to the small intestine.
4. The connections are sewn together to ensure no leaks.
5. The incision is closed with sutures or staples.

Tools and equipment include surgical staples, sutures, and specialized surgical instruments. General anesthesia ensures the patient remains unconscious and pain-free.

Duration

The procedure typically takes 2 to 4 hours.

Setting

The procedure is performed in a hospital's operating room.

Personnel

• Thoracic surgeon
• Anesthesiologist
• Operating room nurses and surgical technicians

Risks and Complications

• Infection at the surgical site.
• Leakage from the esophagojejunostomy connection.
• Respiratory complications from the thoracic approach.
• Blood clots or bleeding.
• Reactions to anesthesia.
• Postoperative pain.

Benefits

• Improved ability to swallow and digest food.
• Relief from symptoms related to obstruction or motility disorders.
• Potentially lifesaving for patients with malignant obstructions.

Recovery

• Patients typically stay in the hospital for 5 to 10 days post-operation.
• Initial feeding might be through IV or a tube until normal eating resumes.
• Gradual return to a normal diet as tolerated.
• Follow-up appointments to monitor recovery and surgical site integrity.

Alternatives

• Total gastrectomy with esophagojejunostomy.
• Endoscopic stent placement to bypass obstructions.
• Radiation or chemotherapy for malignant conditions.
• Pros: Less invasive options might result in shorter recovery times.
• Cons: May not be as effective in severe cases.

Patient Experience

Patients will feel little to no pain during the procedure thanks to anesthesia. Post-procedure, they can expect some discomfort or pain in the chest, which will be managed with pain medications. Hospital staff will assist with mobility and daily activities initially before the patient gradually resumes normal routines.