Surgery of the esophagus is conducted for perforation, cancer, reflux and other conditions.
GERD Esophageal surgery can be conducted for gastroesophageal reflux disease or acid reflux. This is a condition in which the acidic juices in the stomach leak into the esophagus. Surgical intervention tightens and restructures the area using laparoscopy. Several small incisions are made in the abdomen and the upper portion of the stomach is wrapped up around the base of the esophagus.
Surgery for corrosive esophageal injury: Intentional or accidental ingestion of corrosive acid or alkali can lead to severe injury of the esophagus and or stomach. A good number of these patients respond well to endoscopic dilatation while some of them will require surgery. A transhiatal esophageal resection is performed for corrosive injury. A gastric pull-up or colon pull-up is performed to replace damaged esophagus.
Esophageal Cancer Surgery: Cancer of the esophagus commonly seen in chronic smokers presents with dysphagia (inability to swallow) and progressive weight loss. The cancer along with the surrounding normal tissue can be removed surgically. Lower third and middle third cancers of the esophagus are amenable to surgical treatment in the form of removal of the esophagus called esophagectomy. Esophagectomy are of two types open esophagectomy and minimally invasive esophagectomy.
- Open esophagectomy can be approached as transthoracic esophagectomy where the part of the esophagus is removed through small incisions in the chest and abdomen. It can also be approached as transhiatal esophagectomy where incisions are made in the abdomen and neck. In some procedures incisions are made through all three avenues, the abdomen, chest and neck.
- Minimally invasive esophagectomy is a procedure that is performed for small cancers, where surgical instruments are inserted through small incisions and a scope is inserted to view inside the organs during the operation.
Surgery for cancer of GE junction Cancer of the gastro-esophageal junction requires removal of the esophagus and part of the stomach. This procedure is called esophago-gastrectomy. The remaining stomach is then pulled up through the chest and anastomosed to the esophagus in the neck.
Achalasia cardia – Achalasia cardia is functional and motor disorder of the esophagus. The lower sphincter of the esophagus fails to relax and there is high body peristalsis. It is a benign condition where there is an obstruction at the lower end of the esophagus quite often treated by balloon dilatation. Failure of balloon treatment will require surgery in the form of – Laparoscopic / open cardiomyotomy.