Name of the Procedure:

Gastrointestinal reconstruction for previous esophagectomy, for obstructing esophageal lesion or fistula, or for previous esophageal exclusion; with colon interposition or small intestine reconstruction, including intestine mobilization, preparation, and perfusion.

Summary

Gastrointestinal reconstruction is a surgical procedure aimed at restoring the continuity of the digestive tract in patients who have had an esophagectomy (removal of the esophagus) or severe esophageal damage. The operation involves reconstructing the esophagus using a segment of the colon or the small intestine to create a new esophageal pathway.

Purpose

This procedure addresses issues arising from esophagectomy, obstructing esophageal lesions, or fistulas. The goals are to restore normal swallowing and digestion, relieve symptoms of obstruction or fistula, and improve the patient’s quality of life.

Indications

• Patients with a history of esophagectomy needing gastrointestinal tract continuity.
• Obstructing esophageal lesions.
• Esophageal fistula formation.
• Cases of previous esophageal exclusion where reconstruction is warranted.

Preparation

• Fasting typically required for 8-12 hours before surgery.
• Adjustment or discontinuation of certain medications as directed by the surgeon.
• Preoperative diagnostic tests such as imaging, endoscopy, and blood tests.
• Anesthesia evaluation to ensure the patient is fit for surgery.

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Incision: The surgeon makes an incision in the abdomen, chest, or neck depending on the surgical approach.
3. Mobilization: The colon or segment of the small intestine is carefully mobilized and prepared.
4. Preparation & Perfusion: Ensuring adequate blood supply to the selected intestinal segment.
5. Reconstruction: The prepared intestinal segment is interposed between the residual esophagus and the stomach.
6. Anastomosis: The ends of the intestine are connected (anastomosed) to the esophagus and stomach to restore the continuity of the gastrointestinal tract.
7. Closure: The incision is closed with sutures or staples.

Duration

The procedure typically takes 4-6 hours but can vary based on the complexity of the case.

Setting

The procedure is performed in a hospital's operating room.

Personnel

• Lead surgeon (gastrointestinal or thoracic surgeon).
• Surgical assistants.
• Operating room nurses.
• Anesthesiologist.
• Scrub techs and other support staff.

Risks and Complications

• Infection at the surgical site.
• Leakage from the anastomosis site.
• Blood clots or bleeding.
• Pneumonia or respiratory complications.
• Stricture (narrowing) of the reconstructed section.
• Delayed gastric emptying or bowel function issues.

Benefits

• Restoration of normal swallowing and nutritional intake.
• Relief from symptoms associated with esophageal obstruction or fistulas.
• Improved quality of life and reduced reliance on feeding tubes.

Recovery

• Postoperative care in the ICU initially, followed by transfer to a regular hospital room.
• Pain management with medications.
• Gradual reintroduction of oral intake, starting with liquids and progressing to solids.
• Physical activity limitations and gradual resumption of normal activities.
• Follow-up appointments for monitoring recovery and addressing any complications.

Alternatives

• Esophageal stenting for less severe cases.
• Total parental nutrition (TPN) for patients unable to tolerate surgery.
• Palliative care approaches for advanced disease stages.

Patient Experience

Patients may experience discomfort and pain managed with medication. There may be a temporary inability to eat orally, necessitating a slow dietary advancement. Recovery involves a hospital stay and a gradual return to normal activities, with some restrictions on physical exertion. Pain and discomfort typically decrease steadily with proper postoperative care.