43352 Esophagostomy, fistulization of esophagus, external; cervical approach

Name of the Procedure:

Esophagostomy, fistulization of esophagus, external; cervical approach

• Common Name: Cervical Esophagostomy
• Technical Term: External Cervical Esophagostomy, Fistulization of Esophagus

Summary

The cervical esophagostomy is a surgical procedure where an opening is created in the cervical region (the neck area) of the esophagus to allow food and liquids to bypass a damaged or obstructed part of the esophagus. This opening, or stoma, connects the esophagus directly to the outside of the neck.

Purpose

The procedure addresses severe conditions where the esophagus is non-functional due to disease, injury, or obstruction. The goals are to enable the patient to intake nutrition and fluids, alleviate symptoms such as difficulty swallowing, and improve the patient’s quality of life.

Indications

• Severe esophageal strictures or obstructions.
• Esophageal cancers.
• Traumatic injury to the esophagus.
• Conditions causing severe dysphagia (difficulty swallowing).
• Failed previous esophageal surgery.

Preparation

• Fasting typically required for 8 hours before surgery.
• Discontinuation or adjustment of certain medications as directed by the physician.
• Preoperative diagnostic tests, such as barium swallow studies, CT scans, or endoscopy.
• Pre-surgical evaluation for anesthesia.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made in the cervical area of the neck.
3. The surgeon identifies and isolates the esophagus.
4. A fistula (an artificial opening) is created in the esophagus.
5. The esophagus is brought to the skin surface and sutured to the skin to form a stoma.
6. The incision is closed, and a protective dressing is applied.

The tools involved include surgical scalpels, retractors, sutures, and specialized instruments for creating the stoma.

Duration

The procedure typically takes 1-2 hours.

Setting

Performed in a hospital operating room or a specialized surgical center.

Personnel

• Surgeon (typically a thoracic or general surgeon)
• Anesthesiologist
• Surgical nurses and assistants

Risks and Complications

• Infection at the surgical site.
• Leakage around the stoma.
• Stricture or narrowing of the stoma.
• Bleeding.
• Injury to surrounding neck structures.
• Difficulty in stoma management.

Benefits

• Improved ability to intake nutrition and fluids.
• Relief from the symptoms associated with esophageal obstruction or damage.
• Enhanced quality of life through better management of feeding.

Recovery

• Post-procedure monitoring in a recovery room.
• Nutritional support given through the stoma after healing.
• Instructions on stoma care and management.
• Follow-up appointments to monitor healing and function.
• Recovery period varies, but patients may expect to resume normal activities in a few weeks with ongoing stoma care.

Alternatives

• Esophageal dilation.
• Esophagectomy (surgical removal of the esophagus).
• Tube feeding via gastrostomy or jejunostomy.
• Each alternative has its own set of benefits and risks, depending on the specific patient condition.

Patient Experience

• During the procedure, the patient is under general anesthesia and will not feel pain.
• Post-procedure, pain managed with medication; discomfort at the incision site is possible.
• Patients might initially find stoma management challenging but will receive guidance and support.
• Rehabilitation and learning to manage the stoma are important parts of the recovery process.