Partial esophagectomy, thoracoabdominal or abdominal approach, with or without proximal gastrectomy; with colon interposition or small intestine reconstruction, including intestine mobilization, preparation, and anastomosis(es)
CPT4 code
Name of the Procedure:
Partial Esophagectomy, Thoracoabdominal or Abdominal Approach, with or without Proximal Gastrectomy; with Colon Interposition or Small Intestine Reconstruction, including Intestine Mobilization, Preparation, and Anastomosis(es).
Summary
This complex surgical procedure involves removing a portion of the esophagus and possibly the upper part of the stomach. The surgeon then reconstructs the digestive tract using a segment of the colon or small intestine. This surgery is typically performed through an incision in the chest and/or abdomen.
Purpose
The primary aim is to treat esophageal cancer or severe esophageal damage. The expected outcomes include the removal of diseased tissue, restoration of normal swallowing and digestion, and improvement in quality of life.
Indications
- Esophageal cancer
- Severe esophageal stricture
- Advanced Barrett's esophagus with high-grade dysplasia
- Previous failed esophageal surgeries
Preparation
- Patients must fast for at least 8 hours before the surgery.
- Blood tests, imaging studies, and an endoscopy may be required.
- Discuss any current medications with the surgeon, and adjustments might be necessary.
Procedure Description
- The patient is administered general anesthesia.
- The surgeon makes an incision in the chest or abdomen.
- A section of the esophagus and possibly part of the stomach is removed.
- The colon or small intestine is mobilized and prepared for interposition.
- The digestive tract is reconstructed by connecting the mobilized colon or small intestine to the remaining esophagus and stomach, forming an anastomosis.
- The incisions are closed, and the patient is moved to recovery.
Duration
The procedure typically takes between 5 to 7 hours.
Setting
The surgery is performed in a hospital operating room.
Personnel
The surgical team includes:
- A thoracic or gastrointestinal surgeon
- An anesthesiologist
- Surgical nurses
- Possibly a surgical oncologist
Risks and Complications
Common risks:
- Infection
- Bleeding
- Anastomotic leakage
Rare complications:
- Respiratory issues
- Strictures at the anastomosis site
- Nutritional deficiencies
Benefits
Successful removal of diseased tissue, alleviation of symptoms, and improved ability to swallow and digest food. Benefits may be realized immediately post-recovery or over several weeks.
Recovery
- Patients will stay in the hospital for 7 to 14 days.
- Pain management will be provided.
- Gradual reintroduction of diet starting with liquids.
- Follow-up appointments are crucial for monitoring recovery and managing any complications.
Alternatives
- Chemotherapy or radiation therapy for patients unfit for surgery.
- Endoscopic treatments for less advanced conditions.
- Palliative care options for terminal cases.
Pros and cons of alternatives should be discussed with the healthcare provider.
Patient Experience
Patients can expect postoperative pain, which will be managed with medication. There may be tubes for drainage and nutrition support initially after surgery. Gradual improvement in swallowing and eating will be observed as recovery progresses.