Complete or partial removal of the esophagus may be required in advanced cases of esophageal cancer and other conditions that damage the body’s food tube. A surgical procedure, esophagectomy (also called esophageal resection) entails removing the esophagus and using a portion of the stomach to create a “new” esophagus to allow patients to eat normally.
At NorthShore, our dedicated and specially-trained thoracic surgeons and general surgeons have extensive experience using minimally invasive approaches to an esophagectomy. We perform minimally- invasive esophagectomies via video assisted thoracoscopic surgery (VATS) and laparoscopy. This advanced technique involves the use of a tiny camera and pencil-thin endoscopic tools. These surgical instruments are inserted into the chest and abdomen via small incisions. Unlike traditional open surgery, minimally invasive surgery is done without the need for large incisions. This advanced technique offers:
- less pain
- quicker recovery
- smaller incisions and less scarring
- fewer chances of infection
More than 95 percent of esophageal resections are performed at NorthShore using a minimally-invasive approach.
Preparing for an Esophagectomy
You may need to be seen by your primary care physician and general surgeon prior to undergoing the procedure. Your pre-operative clearance will include a discussion of your medical history and a physical exam. You may also be required to undergo several diagnostic tests, including:
One week prior to the esophagectomy, you will need to undergo laparoscopic preconditioning with one of NorthShore’s general surgeons specializing in minimally invasive procedures. This advanced approach involves 5 small incisions in the abdomen and the use of a laparoscope to aid the surgeon in mobilizing or freeing the stomach in preparation for the esophageal resection. A sampling of lymph nodes will be taken at this time around the area of the tumor. The laparoscopic procedure prepares the stomach for esophagectomy and will help ensure good blood flow to the “new esophagus.”
What to Expect
The esophagectomy is performed under general anesthesia and consists of three main parts:
- VATS or Thoracoscopy
VATS involves several small incisions made under the arm and between the ribs on the right side of your chest. The incisions range in size from about 1 to 2 inches. Your surgeon will use VATS to release the esophagus from surrounding tissues, from the upper part to the lowest part of your chest.
- Laparoscopy, Transhiatal Esophagectomy and Jejunostomy Placement
Laparoscopy is again performed, through the same incisions as laparoscopic preconditioning, to complete the removal of the esophagus. This part of the procedure includes taking a small portion at the top of the stomach. Your surgeon will use a specialized stapler to remove and seal off the esophageal tissue simultaneously.
The remainder of the stomach is then pulled up through the opening in the diaphragm (hiatus) in preparation for attaching it to the remnant of esophagus in the neck to create your "new esophagus.”
Additionally, a feeding tube, or jejunostomy tube, is placed in the abdomen to provide nutritional support during your recovery.
- Neck Anastomosis
The connection between the portion of the stomach and the remnant of esophagus is completed using a combination of a specialized stapling device and suturing. Your "new esophagus" is now complete.
After the procedure, your pain will be controlled using one of several methods: a pump that delivers pain medicine through your intravenous line at your demand, by a nurse administering medicine through your intravenous line at your request or through oral medicines.
A typical hospital stay for an esophagectomy is 6 to 10 days. After your discharge, you will want to make arrangements to have someone with you for the first couple of days if you live alone. You will not be able to drive until you are off of pain medicines. You will receive detailed instructions on dietary guidelines to follow to ensure good nutrition as you get use to your new esophagus.
For More Information
To schedule an appointment with one of our thoracic surgeons, please call 847.570.2868.