Esophagoplasty (plastic repair or reconstruction), thoracic approach; with repair of tracheoesophageal fistula
CPT4 code
Name of the Procedure:
Esophagoplasty, thoracic approach with repair of tracheoesophageal fistula.
Common name(s): Esophagus reconstruction, Tracheoesophageal fistula repair.
Summary
Esophagoplasty is a surgical procedure to reconstruct or repair the esophagus, the tube that connects the throat to the stomach. The thoracic approach involves accessing the esophagus through the chest. This procedure also includes repairing a tracheoesophageal fistula, an abnormal connection between the esophagus and the trachea (windpipe).
Purpose
This procedure aims to correct structural problems in the esophagus and trachea, allowing for normal swallowing and breathing functions. It addresses congenital defects, injuries, or severe damage to the esophagus and trachea.
Indications
- Congenital tracheoesophageal fistula
- Severe esophageal injury or trauma
- Esophageal stricture or blockage
- Severe gastroesophageal reflux disease (GERD) causing esophageal damage
- Esophageal cancer or tumors requiring reconstruction
Preparation
- Fasting for at least 8 hours before the procedure
- Adjustments to medications, especially blood thinners
- Preoperative diagnostics such as chest X-rays, CT scans, endoscopy, or esophagram
- Preoperative meeting with surgical and anesthesia teams
Procedure Description
- The patient is administered general anesthesia to ensure they are asleep and pain-free.
- A surgical incision is made in the chest (thoracic approach) to access the esophagus and trachea.
- The esophagus is repaired or reconstructed as needed, which may involve removing damaged sections.
- The tracheoesophageal fistula is identified and meticulously closed to prevent any abnormal communication between the esophagus and trachea.
- The surgical site is closed, and the patient is monitored for immediate postoperative recovery.
Tools and Equipment:
- Scalpel
- Surgical retractors
- Suturing materials
- Specialized instruments for thoracic surgery
Duration
3 to 6 hours, depending on the complexity of the case.
Setting
Usually performed in a hospital setting, particularly in an operating room equipped for thoracic surgery.
Personnel
- Thoracic surgeon
- Surgical nurses
- Anesthesiologist
- Respiratory therapist (if needed)
- Operating room technicians
Risks and Complications
- Infection
- Bleeding
- Anesthesia-related complications
- Esophageal or tracheal leakage
- Recurrent fistula
- Respiratory difficulties
- Long-term swallowing problems
Benefits
- Improvement in swallowing and breathing
- Resolution of infections caused by the abnormal connection
- Better quality of life and nutritional status
- Reduced risk of future complications from the fistula
Recovery
- Initial hospitalization for monitoring, typically 1 to 2 weeks
- Pain management through medications
- Gradual reintroduction of feeding, starting with liquids
- Follow-up appointments to monitor healing and function
- Avoidance of strenuous activity for 6 weeks
Alternatives
- Endoscopic repair (less invasive, may be suitable for small fistulas)
- Conservative management (for minor symptoms)
- Palliative care (if surgery risks outweigh benefits)
Patient Experience
Patients will be under general anesthesia during the procedure and will not feel any pain. Postoperatively, they may experience discomfort or pain managed with medications. A temporary feeding tube may be necessary during the initial recovery phase, and breathing support might be provided if needed. Follow-up care is essential for monitoring and ensuring successful recovery.