Esophagectomy, distal two-thirds, with laparoscopic mobilization of the abdominal and lower mediastinal esophagus and proximal gastrectomy, with laparoscopic pyloric drainage procedure if performed, with separate thoracoscopic mobilization of the middle a
CPT4 code
Name of the Procedure:
Esophagectomy, distal two-thirds, with laparoscopic mobilization of the abdominal and lower mediastinal esophagus and proximal gastrectomy, with laparoscopic pyloric drainage procedure if performed, with separate thoracoscopic mobilization of the middle esophagus.
Summary
In layman's terms, this procedure involves surgically removing the lower two-thirds of the esophagus and part of the stomach using minimally invasive techniques. The surgical team employs laparoscopic (small incisions and camera-guided tools) and thoracoscopic (chest cavity) methods to access and excise the affected areas, and may also include steps to aid stomach drainage.
Purpose
This surgery is primarily used to treat conditions such as esophageal cancer, severe esophageal stricture, or high-grade dysplasia. The goal is to remove diseased tissue, improve swallowing ability, and prevent the spread of malignancy, if present.
Indications
- Diagnosed with esophageal cancer, especially in the lower two-thirds.
- Severe esophageal stricture unresponsive to other treatments.
- High-grade dysplasia in the esophagus.
- Other conditions where the esophagus structure and functionality are severely compromised.
Preparation
- Fasting for at least 8 hours before the procedure.
- Possible bowel preparation.
- Pre-operative imaging (CT scan, PET scan) and endoscopic assessment.
- Blood tests and other routine diagnostic exams.
- Consultation to adjust medications, especially blood thinners.
Procedure Description
- Anesthesia: General anesthesia is administered.
- Laparoscopic Mobilization: Small incisions are made in the abdomen to insert camera and instruments.
- Lower Mediastinal Mobilization: The esophagus is separated from surrounding tissues.
- Proximal Gastrectomy: Part of the stomach is removed if necessary.
- Thoracoscopic Mobilization: Another set of small incisions is made in the chest to access the middle portion of the esophagus.
- Pyloric Drainage Procedure: A technique to improve gastric emptying may be performed if required.
- Reconstruction: The remaining portion of the esophagus is connected to the stomach or small intestine.
Duration
The procedure typically takes 5-7 hours.
Setting
The procedure is performed in a hospital operating room.
Personnel
- Surgeon specialized in thoracic or gastrointestinal surgery.
- Surgical nurses.
- Anesthesiologist.
- Assistants and possibly an oncologist, depending on the underlying condition.
Risks and Complications
- Infection.
- Bleeding.
- Anastomotic leak (leakage where the esophagus and stomach are reconnected).
- Respiratory complications.
- Recurrent laryngeal nerve injury.
- Gastroesophageal reflux or aspiration.
Benefits
- Removal of cancerous or precancerous tissue.
- Improved swallowing function.
- Potentially prolonged survival in cancer patients.
- Alleviation of symptoms such as pain and difficulty eating.
Recovery
- Hospital stay of 7-10 days post-surgery.
- Initial feeding through a tube, progressing to liquids and then soft foods.
- Pain management with medications.
- Light activity is encouraged, but heavy lifting is restricted.
- Follow-up appointments, including imaging and possibly endoscopy, to monitor recovery and healing.
Alternatives
- Radiation therapy and/or chemotherapy.
- Stenting to keep the esophagus open.
- Palliative care for symptom management.
- Endoscopic mucosal resection for small, localized lesions.
- Each alternative has its own set of risks and benefits, and decisions are based on individual patient circumstances.
Patient Experience
- The patient may feel soreness and need pain management post-surgery.
- Initial discomfort around the incisions.
- Gradual improvement in the ability to eat and swallow.
- The care team will provide comfort measures and support throughout recovery.
This markdown document provides a comprehensive overview of the esophagectomy procedure, aiming to inform patients and healthcare professionals alike.