Lap Assisted Transhiatal Esophagectomy

Esophagus also known as food pipe is the tract through which the food we eat reaches the stomach. Inner layer of esophagus consists of mucosa. Mucosa keeps the inner part of the food pipe wet and helps the food to go down easily. Sometimes tumor or cancerous cells grow inside esophagus which can be dangerous and life threatening. Outer cells of the inner layer of esophagus may get inflicted by cancer and spread to the tissues in the neighboring layers. Esophageal cancer is a dangerous disease. Earlier detection and removal of the diseased part of the esophagus is the only solution available to this type of cancers. Transhiatal esophagectomy is the medial name of the surgery carried out to remove the cancerous portion of the esophagus. The patients in the early stages of esophageal cancer only will be benefitted by this surgery. Removal of esophagus can be done through the conventional method of open surgery or through minimally invasive laparoscopic surgery.

Laparoscopic procedure

A laparoscope is inserted into the stomach through a small incision in the naval of the size 1 to 2 cms. Laparoscope is a special instrument with a video camera and a light source connected to a long flexible wire, the other end of which is connected to a video monitor usually placed in front of the surgeon performing the surgery. Through other small incisions of the same size near the incision for the laparoscope the surgeon carefully inserts and guides till the surgical site, the other special instruments needed for the surgery. Surgeon views the video showing the internal parts and the surgery being carried out, and performs the surgical procedure controlling the instruments from outside the body. Carbon dioxide will be pumped to the stomach to enlarge the cavity and make more room for the surgical procedure and to get a clear view of the surgical area. The surgeon will make another cut below the neck in the front side. Through this hole the upper portion of the esophagus is cut. The remaining portion of the stomach after it is cut is pulled through the hiatus which is the hole in the diaphragm. For this purpose a cut about 4 cms in diameter is made in the abdomen through which a tube is inserted and taken out through another incision made the lower front side of the neck. The stomach is pulled through hiatus with the help of this tube. The stomach so pulled up is attached to the cut portion of the esophagus and is joined together either by suturing or by stapling which can be done through the hole in the neck. This surgery is done under general anesthesia.

Risk factors

Leak in internal suture is a probable risk factor Infection and bleeding are also possible in such surgeries Problems connected with the function of the heart can also be developed as a side effect of this surgical procedure. Advantages of laparoscopic procedure 1 As the incisions are smaller there will be little pain and the healing will be faster. 2 Period of hospital stay, recovery and returning to normal activates are easier and faster. 3 The scars will be very small and will not be visible after healing.

After the surgery

After the surgery it is possible that some complications may develop. So the patient may be asked to stay in the hospital for some time more. Complete recovery may take a period about three to six months. The surgeon may advise a change in the dietary habits of the patient. Taking small quantities of food which are less fatty and spicy will be preferred by the surgeon. The patient is expected to chew well and eat slowly. He will also be required to sit or stand upright while eating food and for some time after the food intake.