Name of the Procedure:

Closure of Esophagostomy or Fistula; Cervical Approach

Summary

This surgical procedure involves closing an abnormal opening (esophagostomy or fistula) in the esophagus through an incision made in the neck (cervical approach). The esophagus is the tube that carries food from the throat to the stomach, and such openings can disrupt normal function and cause complications.

Purpose

The procedure aims to repair abnormal openings in the esophagus, which can result from injury, surgery, or disease. The goal is to restore normal esophageal function and prevent complications like infection, food leakage, or aspiration.

Indications

• Persistent esophagostomy or fistula causing symptoms like difficulty swallowing, recurrent respiratory infections, or leakage of food and fluids.
• Congenital esophageal fistulas.
• Acquired fistulas due to trauma, previous surgeries, radiation therapy, or infections.
• Patients experiencing complications from esophagostomy tubes.

Preparation

• Patients may be required to fast for 8 hours before the procedure.
• Medication review and adjustments, especially for blood thinners.
• Pre-operative imaging studies such as a barium swallow, CT scan, or MRI to assess the fistula.
• Blood tests to check overall health and readiness for surgery.

Procedure Description

1. The patient is positioned and given general anesthesia for complete sedation.
2. A surgical incision is made in the neck to access the esophagus.
3. The surgeon identifies the fistula or esophagostomy site.
4. The abnormal opening is carefully closed using sutures or surgical staples.
5. Additional reinforcement techniques, such as using a tissue flap, may be employed to ensure a secure closure.
6. The incision is closed, and a drainage tube may be placed to prevent fluid accumulation.

Duration

The procedure typically takes 2 to 4 hours, depending on the complexity of the fistula and any additional reparative work needed.

Setting

The procedure is performed in a hospital operating room.

Personnel

• General or thoracic surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technician

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma
• Injury to nearby structures such as nerves or blood vessels
• Recurrence of the fistula
• Anastomotic leak (leakage at the surgical connection site)
• Difficulty swallowing post-operation
• Temporary or permanent hoarseness due to nerve involvement

Benefits

• Resolution of symptoms associated with the fistula
• Reduced risk of infections and respiratory problems
• Improved swallowing and esophageal function
• Enhanced quality of life

Recovery

• Patients typically stay in the hospital for a few days post-surgery for monitoring.
• Pain management with prescribed medications.
• Gradual reintroduction of oral intake, starting with liquids.
• Post-operative care instructions, including wound care and activity restrictions.
• Follow-up appointments to monitor healing and address any complications.

Alternatives

• Conservative management with diet modification and tube feeding
• Endoscopic procedures if the fistula is accessible and suitable for less invasive techniques
• The pros of surgical closure include thorough repair and lower recurrence risk, while the cons include higher immediate surgical risks and longer recovery.

Patient Experience

• Patients will be under general anesthesia, so they will not feel anything during the procedure.
• After the procedure, patients may experience soreness in the neck and throat.
• Pain management protocols will be in place to ensure comfort.
• Swelling and bruising are common and usually resolve within a couple of weeks.
• Instructions will be provided for post-operative care and activity limitations to facilitate smooth recovery.