Indications for esophagectomy

Esophageal anastomosis is the removal of part or all of the esophagus to remove damage and re-establish circulation by means of an anastomosis. Esophageal resection is indicated in cases of esophageal perforation, esophageal stricture, esophageal tumor, esophageal cancer, esophageal malformation,...

Esophageal anastomosis is a method of removing part or all of the esophagus to remove damage to the esophagus and then restore circulation by an anastomosis. Anastomosis is performed by manual suture or gastrostomy machine. Esophageal resection or anastomosis can only involve cervical esophagus, lower esophagus, thoracic esophagus, or to the whole, so the incision can be coordinated, the esophagectomy team must have other majors.

Esophageal anastomosis is indicated in the following cases:
Esophageal tumor Perforation Esophageal cancer Esophageal stricture Esophageal stricture: Due to burn scars, fistula sequelae, or inflammation,...

There are no absolute contraindications for esophagectomy.

People performing esophagectomy include:
01 Gastroenterology or general surgery surgeon 02 assistants Anesthesiology team: 01 anesthesiologist and 01 assistant anesthesiologist Team of equipment: 01 equipment, 01 staff running outside For patients:
Have been diagnosed with the disease, done biological tests, assessed the disease in coordination and been treated, nourished, and balanced enough to ensure health for scheduled surgery. Improve physical condition, balance disorders caused by the consequences of diseases or chronic diseases, age, location,... The patient and family are clearly explained before surgery about the medical condition and the general condition, the possibilities that may occur when performing surgery, the possible complications, complications and sequelae due to the disease, surgery, the patient's location, anesthesia, anesthesia, pain relief,... The patient needs to fast, enema, and clean the surgical area and the whole body before surgery.

The estimated time for esophagectomy is 240 minutes. First put the patient in one of the following positions:
Cervical esophagectomy: Lying supine with left neck flexed. If thoracotomy to enter the right pleural space: Left side or 30 degree prone position. Lying supine position with pillow under the sternum in abdominal phase. After that, endotracheal anesthesia, actively prepare for a collapsed lung, ventilate one lung. Surgical steps include:
Step 1: Incision of the skin in the left neck area in front of the sternocleidomastoid muscle, through the left carotid trough towards the anterior cervical spine, dissecting the cervical esophagus, exposing the cervical esophagus and identifying the lesion. injury, resection of the cervical esophagus. Depending on the type of surgery, the mouth connects the cervical esophagus to the lower end. Esophageal anastomosis hand-stitched with surgical sutures or gastrostomy machine.

Step 2: Make a posterior incision on the side of the intercostal space to open the chest into the right pleural space. Actively deflate and ventilate one lung. Posterior mediastinal incision for finding and resection of esophageal lesions can be done with an automatic cutter or an electric knife. Make an esophageal anastomosis at the neck or in the mediastinum. Esophageal anastomosis is performed by hand suturing with surgical sutures or a gastrostomy machine. Place a drainage system for fluid and air in the pleural space that needs to be aspirated continuously with a pressure of 20cmH2O. Sew and close the right pleural cavity according to the routine procedure Step 3: Cut the esophagus through the diaphragmatic fissure by making an incision in the middle skin above the navel, into the abdominal cavity. Dissection of the esophagus and the center of the stomach bulges from the diaphragmatic foramen, through the diaphragmatic cleft, dissects the esophagus toward the mediastinum. Identify the lesion and resect the esophageal lesion with a clipper or electrocautery. Esophageal anastomosis on the left neck or in the mediastinum by hand suturing with surgical sutures or an gastrostomy machine. One or both sides of the pleural air drainage system can be placed, followed by continuous suction pressure of 20 cmH2O. Step 4: Close the abdominal incision with the middle white line as usual.

Care and follow-up issues after esophagectomy include:
Full body follow-up care: Post-operative recovery care and routine resuscitation. Respiratory: Support the patient to practice breathing for good lung expansion and help prevent airway obstruction. At the same time, take care of the continuous suction drainage system in the pleural space and at the left neck incision. Monitor the incision for septic bleeding. Bleeding at the incision: Conservative treatment and monitoring or surgical hemostasis. Esophageal anastomosis is not close or fistula causes infection: Conservative treatment with drainage or surgery to treat the infection and drain it out. Chylous effusion: The patient needs complete fasting and parenteral nutrition. Surgical suturing of the thoracic duct or conservative drainage treatment. Narrow anastomosis after surgery: It is necessary to perform dilation of the stricture by gastrointestinal endoscopy or plastic surgery to treat stenosis of the anastomosis. In a nutshell, esophagectomy is the removal of part or all of the esophagus to remove damage and then re-establish circulation by means of an anastomosis. Esophageal resection is indicated in cases of esophageal perforation, esophageal stricture, esophageal tumor, esophageal malformation,...
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