Esophagectomy is the removal of the esophagus, a last resort in the treatment of the digestive tract. This method is chosen for oncological diseases and other pathologies of the esophagus, when conservative methods of treatment are ineffective. Depending on the severity of the course of the disease, the stage of development of the esophagus is removed partially or completely. The body recovers in a few months, the operated organ does not bring obvious discomfort or its complete absence, but it is imperative to reconsider nutrition. The removal of any of the organs is considered a last resort to save human he alth.
Description
Surgery on the esophagus consists in cutting off part of the organ (resection of the esophagus) or its complete replacement with an implant. The main prerequisite for removal is manifested by dysfunction of individual parts of the organ. This is manifested by insufficiency of the lower section, while the gastroesophageal reflex is prevented by a rosette of the mucous membrane of the cardia.
The esophagus is an intermediate organ that is in the process ofDigestion transfers food from the mouth to the stomach. When removing even a small part of the esophagus, its replacement and strengthening is required. This will keep the digestive system intact. For resection, there are different methods, their choice depends on the qualifications of the surgeon and the individual characteristics of the patient. When is esophageal surgery scheduled?
Indications for surgery
As already noted, surgical interventions on the esophagus are resorted to in extreme cases in the treatment of insufficiency of the digestive system, to ensure the closure of the passage, so the indications must be serious. Resection is assigned:
- With erosive esophagitis - severe inflammation of the rosette of the mucous membrane of the cardia in the upper part. Surgery is appropriate if there is a gradual closure of the lumen, and therapeutic methods have not achieved the desired result.
- Barrett's esophagus with a lot of cell change. Thanks to radical methods of treatment, the patient is saved from the formation of oncology.
- Mediastinitis - inflammation in the middle region of the sternum, caused by a large foreign body in the esophagus. It presses against the walls, the passage closes.
- Mechanical, chemical damage to the body, narrowing. If timely surgical intervention is not carried out, it will be quite difficult to maintain the non-closure of the passage, and the consequences will manifest themselves in acute failure of the lungs, liver, kidneys, stomach.
- Hernia of the esophagus. The operation is performed quite often.
- Rake. If a malignant tumor has developed, this requires partial orcomplete withdrawal of the esophagus. This is influenced by the degree of development of the oncological process. Esophagectomy will be the main treatment for cancer.
How to identify the need for surgery on the esophagus?
The main symptoms cannot become a significant reason for surgical intervention, the operation requires a specific diagnosis, based on which the doctor will determine the need for radical measures.
Careful examination is required to clarify the diagnosis, especially if a tumor of the esophagus is suspected (the operation in this case should be immediate). Diagnosis includes:
- fluorography of the esophagus - an increase in the lumen of the esophagus, restructuring of the relief of the mucous membrane, outlines and their unevenness;
- esophagomanometry - determine the displacement of the cardia into the posterior mediastinum (such as cardia insufficiency);
- endoscopy;
- biopsy;
- analysis for tumor markers;
- endoscopic optical coherence tomography.
How to prepare for the procedure?
Any surgical intervention will be a serious burden on the body. It is important to adhere to preoperative recommendations so that there are no negative consequences:
- you need to keep high blood pressure, diabetes, pathologies in the stomach, heart failure under control and supervision of a doctor;
- follow all dietary recommendations;
- never take blood thinning drugs -vitamin E, aspirin;
- not worth takingdrugs that reduce muscle tone, as they affect the cardiac sphincter;
- it is necessary to refrain from smoking a month before surgery on the esophagus - nicotine sharply increases blood pressure and leads to malfunctions in the respiratory system. You need to be ready to take tests for the presence of nicotine in the blood.
Surgery
The procedure depends entirely on the individual patient and on certain signs and symptoms. Surgical intervention takes place in several stages - anesthesia, surgery, postoperative recovery period.
During the operation, general anesthesia is used. With its help, the patient is put into a state of sleep for the duration of the intervention and all pain sensations are blocked. To support the respiratory process, a special tube is placed in the trachea.
Resection of the esophagus lasts an average of six hours. The occurrence of various complications during the surgical procedure, concomitant ailments and the severity of the disease can extend this time. In addition, the time of the operation depends on whether the organ is completely removed or partially. What happens after surgery to remove a hernia of the esophagus? More on that later.
Types of interventions
Operational methods are divided into several types. They make up two groups. Can be radical and palliative.
Radical completely eliminated the affected areas. There are several ways of such surgical interventions:
- Extirpation of the esophagus is called its complete removal. She iswill be appropriate for oncological diseases, Barrett's disease or overall scar formations.
- Resection is the partial removal of the esophagus. This is facilitated by cancer, which has affected a separate part of the organ, while it gradually closes; cicatricial narrowing and inflammation of the rosette of the mucous membrane of the cardia; hernia of the esophagus. The operation is of two types, it can be immediate or secondary.
- Lewis technology is called partial excision with the instant replacement of part of the esophagus with a tube made from stomach tissue.
- The tunnel method of extirpation of the esophagus is an operation that is performed through two incisions in the epigastrium and on the neck, a gaping passage is formed under the skin that connects them.
Palliative operative methods
Needed to maintain the functions of the esophagus, as well as to improve the well-being of the patient. Divided into several types:
- Impose a gastrostomy: if the esophageal plasty cannot be resected, then the patient is inserted a gastric fistula for nutrition, bypassing the esophagus.
- Stenting is performed: a special tube is inserted into the esophagus to ensure that the passage does not close.
- Provides hardening of the veins in the esophagus: often needed in cirrhosis of the liver. Use substances that wrinkle the veins - ethoxysclerols or medical acrylic glue. Until the substances are administered until the veins are completely sclerosed.
- Varicose veins are ligated - this procedure resembles the previous method, but is much longer in duration.
Besidesthe main types are distinguished by several separate operational methods.
Complete removal
To perform this operation, the chest cavity is completely opened. The postoperative prognosis will be generally unfavorable, such therapy is prescribed only for severe forms of esophageal pathology. In this case, the organ is replaced by an implant made from stomach tissue. This can be done immediately or during a second surgery.
The latest minimally invasive technology does less damage, lasts longer, but has a good prognosis.
Therefore, it is more desirable as an alternative to treatment. A tunnel is made under the skin, medical instruments penetrate inside, and then it easily grows together. The esophagus is cut through the upper and lower incisions, then it is removed through the subcutaneous passage.
Resection
Indications for resection of the esophagus are Barrett's disease, cardiospasm, enlarged esophagus in a child at birth. With this procedure, an organ is partially removed from a person, then its subsequent instantaneous replacement is performed - they operate according to the Lewis method.
Laparoscopic intervention
In case of pathologies in the lower parts of the esophagus and the upper esophageal opening in the diaphragm, as well as dysfunction of the rosette of the mucous membrane of the cardia, this type of esophageal operation is prescribed. Treatment in this case will be more effective. This is how the post-hernial openings are sewn and strengthened, the volume of the stomach is reduced, the plasticity of the organ, namely the lowercardia.
Endoscopic procedures
This method is used to remove benign tumors on the mucous membrane, polyps.
This requires ligation of varicose veins, sclerotherapy, laser irradiation, cauterization or exposure to low temperatures on the affected areas.
The main instrument is an endoscopic probe. It has a mini video camera, a set of magnifying lenses and lighting devices. The necessary instruments are inserted into the lumen of the esophagoscope.
What risks and complications can this lead to?
The doctor must warn the patient that the procedure can lead to various negative complications:
- clot formation;
- bleeding;
- infection;
- heart failure during surgery;
- allergic reaction to anesthesia;
- disturbance of the respiratory process.
With open resection of the esophagus, there is a lower risk of complications such as:
- lung injury;
- infection in the chest cavity;
- surgical damage to adjacent organs;
- gradually closing the passage between the esophagus and stomach.
Period after surgery to remove the esophagus
The first week the patient feels weak, he cannot eat on his own. This is assisted by a feeding tube. Doctors look after the patient for about two weeks tothere were no possible leaks in the operated area.
If they are not found, the diet is gradually diluted - soft food is added to the nutrient fluids, and then solid food. Between meals, breathing exercises are shown using the method of deep breathing, which restores the tone of the cardiac sphincter. The patient is provided with a stimulus spirometer, so the load is monitored and gradually increased.
Possibility of dumping syndrome
In simple terms, the intestines reject food. This is due to gastric insufficiency, the loss of the ability to independently digest fats and sugar. Muscle spasms lead to dumping syndrome with diarrhea as the main symptom. Management of symptoms, elimination of the problem is handled by a nutritionist. Six months is enough for a complete restructuring of the body, the stomach will be able to adapt to a new way of life. Nutrition after the operation of the esophagus is of great importance.
Diet
Some time after the operation, nutrients are injected directly into the stomach. Before returning to normal nutrition, the operated organ must be prepared. A clear liquid is injected into the stomach with the necessary content of substances to support life. They do not require much secretion. After two weeks, the digestive system is strengthened, soft foods are gradually introduced into the diet, and over time, more solid.
Due to the small size of the stomach, portions should be small. An important part of postoperative recovery is diet. Selected individually andsuch a principle that it resembles a diet after gastric resection. Operations for cancer of the esophagus and stomach are very similar.
The main point of the diet will be the avoidance of unprocessed, rough, irritating food. It should be more liquid, portions should be small, and receptions should be frequent. A diet is prescribed depending on the individual characteristics of the patient. What can result in surgery to remove the esophagus?
Forecast
The percentage of positive dynamics of recovery is quite large. Medicine is at a high level in surgical intervention. Recently, the number of deaths has decreased, and high-precision technologies and instruments minimize the risk of complications. After a few months, the patient can return to normal eating by following the diet.
This is how esophageal hernia operations are performed (reviews confirm this), as well as other pathologies.
Reviews
Reviews about esophageal surgery are mostly good. There is a positive trend, complications are rare. Especially often the esophagus is operated on for a hernia. It is quite difficult to keep a diet, but over time, the diet expands and becomes diverse.
