43122 Partial esophagectomy, thoracoabdominal or abdominal approach, with or without proximal gastrectomy; with esophagogastrostomy, with or without pyloroplasty

Name of the Procedure:

Partial Esophagectomy, Thoracoabdominal or Abdominal Approach, with or without Proximal Gastrectomy; with Esophagogastrostomy, with or without Pyloroplasty

Summary

A partial esophagectomy involves the surgical removal of a portion of the esophagus, which may include part of the stomach (proximal gastrectomy) and the reconstruction of the digestive tract by connecting the remaining esophagus to the stomach (esophagogastrostomy). It may also involve pyloroplasty, which is a procedure to widen the opening of the pylorus to help with gastric emptying.

Purpose

The purpose of this procedure is to treat esophageal cancer or severe esophageal damage that cannot be managed through less invasive treatments. The goal is to remove the diseased section of the esophagus and maintain as normal a function as possible by reconstructing the digestive tract.

Indications

• Esophageal cancer
• Severe Barrett's esophagus with high-grade dysplasia
• Traumatic injury to the esophagus
• Benign esophageal strictures or other severe non-cancerous esophageal diseases unresponsive to other treatments

Preparation

• Patients are typically required to fast for at least 8 hours before the procedure.
• Medication adjustments, especially blood thinners, may be necessary.
• Preoperative evaluations including blood tests, imaging studies (like CT or PET scans), and possibly endoscopy.
• Discussions regarding the procedure, risks, and recovery expectations with the healthcare team.

Procedure Description

1. Anesthesia is administered to ensure the patient is asleep and pain-free.
2. The surgical area is cleaned and sterilized.
3. An incision is made either through the abdomen (abdominal approach) or both the thorax and abdomen (thoracoabdominal approach).
4. The surgeon removes the diseased portion of the esophagus and, if necessary, a part of the stomach.
5. The remaining esophagus is then connected to the stomach (esophagogastrostomy).
6. If performed, pyloroplasty is done to help the stomach empty contents more easily.
7. Incisions are closed with sutures or staples and the patient is taken to recovery.

Duration

Typically, the procedure takes between 4 to 6 hours.

Setting

This procedure is performed in a hospital setting, specifically in an operating room.

Personnel

• Surgeons specializing in thoracic or gastrointestinal surgery
• Anesthesiologists
• Surgical nurses and technologists
• Postoperative care team

Risks and Complications

• Common risks: infection, bleeding, reactions to anesthesia
• Possible complications: strictures at the surgical site, leakage at the connection (anastomosis) site, respiratory problems, delayed gastric emptying
• Long-term: potential nutritional deficiencies or altered eating habits

Benefits

• Removal of the diseased esophageal tissue
• Improved chances of survival and quality of life in cases of esophageal cancer
• Restoration of more normal swallowing function

Recovery

• Hospital stay typically ranges from 7 to 14 days.
• Initial recovery in an Intensive Care Unit (ICU) may be required.
• Gradual reintroduction of food, starting with liquids then soft solids.
• Instructions on wound care, activity restrictions, and follow-up appointments.
• Full recovery may take several weeks to months, including nutritional adjustments and physical rehabilitation.

Alternatives

• Endoscopic treatments for early-stage cancers
• Chemotherapy and radiation therapy
• Palliative care in non-curable cases
• Less invasive surgical options, if appropriate

Patient Experience

• Patients will be under general anesthesia during the procedure and will not feel anything.
• Pain management will be provided postoperatively, with medications and sometimes a patient-controlled analgesia (PCA) pump.
• Some discomfort, fatigue, and changes in eating habits are common during recovery.
• Support from nutritionists, physical therapists, and support groups can aid in adjusting to lifestyle changes.