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  • Esophagectomy

    (Removal of the Esophagus)

    Definition

    This is surgery to remove part or all of the esophagus. The esophagus is the tube that runs from the mouth to the stomach.

    Reasons for Procedure

    Esophagectomy may be used to treat:
    • Esophageal cancer
    • Benign tumors and cysts of the esophagus
    • Other esophageal abnormalities such as achalasia or Barrett esophagus
    • Severe trauma
    Esophageal Cancer
    Esophageal cancer
    Copyright © Nucleus Medical Media, Inc.

    Possible Complications

    If you are planning to have esophagectomy, your doctor will review a list of possible complications, which may include:
    • Bleeding
    • Blood clots
    • Infection
    • Soreness in throat
    • Adverse reaction to the anesthesia
    • Leaks from the internal suture line
    • Heart attack
    Factors that may increase the risk of complications include:
    Be sure to discuss these risks with your doctor before the procedure.

    What to Expect

    Prior to Procedure

    Your doctor may do the following:
    Leading up to your procedure:
      Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
      • Anti-inflammatory drugs such as ibuprofen
      • Blood thinners
      • Anti-platelet medications
    • Arrange for someone to drive you home from the hospital and to help you at home.
    • Eat a light meal the night before. Do not eat or drink anything after midnight.
    • Your doctor may ask you to:
      • Use an enema to clear your intestines
      • Follow a special diet.
      • Take antibiotics or other medications.
      • Shower using antibacterial soap the night before the surgery.

    Anesthesia

    General anesthesia will be used. It will block any pain and keep you asleep through the surgery. A tube will be placed in your windpipe to help you breathe.

    Description of the Procedure

    Depending on the area that needs to be removed, the doctor will make an incision in the neck or abdomen using one of these techniques:
    • An open procedure using one large incision—The diseased area will be located and removed.
    • A robot-assisted procedure that uses several small incisions—A tiny camera and small surgical instruments will be inserted through the incisions. Looking at the esophagus on a monitor, the doctor will locate and remove the diseased area.
    A replacement esophagus will be formed with part of the stomach or large intestine. The remainder of the esophagus will be attached to this new esophagus. In some cases, lymph nodes in the area will also be removed. One or more chest tubes will be placed to drain fluids. Lastly, the incisions will be closed with stitches or staples.

    How Long Will It Take?

    About six hours

    How Much Will It Hurt?

    You will feel pain as the anesthesia wears off. Ask your doctor about medication to help with the pain.

    Average Hospital Stay

    This procedure is done in a hospital setting. The usual length of stay is 1-2 weeks. Your doctor may choose to keep you longer if complications arise.

    Post-procedure Care

    You will not be able to eat or drink anything during the first week after surgery. You will get nutrition through a feeding tube. Within 7-14 days, you will have a swallowing test to check for leaks. If there are no leaks, your diet will gradually progress from clear liquids to soft, solid meals. You will probably be able to return to a normal diet after about a month. Your stomach may be smaller, so you will need to eat smaller portions.
    You will also need to do deep breathing exercises. You may be given an incentive spirometer. This is a device to help you breath deeply.
    Other guidelines include:
    • Your doctor will encourage you to walk every day.
    • Avoid heavy lifting for 6-8 weeks.
    • Ask your doctor about when it is safe to shower, bathe, or soak in water.

    Call Your Doctor

    After you leave the hospital, call your doctor if any of the following occurs:
    • Signs of infection, including fever and chills
    • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
    • Nausea and/or vomiting that you cannot control with the medications you were given after surgery, or which persist for more than two days after discharge from the hospital
    • Pain that you cannot control with the medications you have been given
    • Cough, shortness of breath, or chest pain
    • Constipation or diarrhea
    • Pain and/or swelling in your feet, calves, or legs
    If you think you have an emergency, call for medical help right away.

    RESOURCES

    American Cancer Society http://www.cancer.org

    National Cancer Institute http://www.cancer.gov

    CANADIAN RESOURCES

    Canadian Cancer Society http://www.cancer.ca

    Health Canada http://www.hc-sc.gc.ca

    References

    Esophagectomy. Boston Medical Center website. Available at: http://www.bmc.org/esophagealtherapies/treatments/esophagectomy.htm. Accessed August 14, 2013.

    Esophagectomy. Massachusetts General Hospital website. Available at: http://www.massgeneral.org/digestive/services/procedure.aspx?id=2296. Accessed August 14, 2013.

    Esophagectomy. Memorial Hermann website. Available at: http://www.memorialhermann.org/digestive/esophagectomy. Accessed August 14, 2013.

    Esophagectomy. University of California San Francisco website. Available at: http://surgery.ucsf.edu/conditions--procedures/esophagectomy.aspx. Accessed August 14, 2013.

    Surgical removal of the esophagus (esophagectomy). UC Davis Health System website. Available at: http://www.ucdmc.ucdavis.edu/surgery/specialties/cardio/esophagus.html. Accessed August 14, 2013.

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