Esophagus Surgery

The esophagus is the tube that allows food to reach the stomach where the digestive process continues. At the top of the tube, muscles relax to allow food or liquid to pass through. At the lower end, the muscles open to allow food to enter the stomach. The upper muscles are called the Upper Esophageal Sphincter, and the lower muscles are the Lower Esophageal Sphincter. A malfunction in the esophagus affects your ability to eat or drink and can cause a good deal of discomfort.

Conditions of the Esophagus Treated

• GERD (Gastroesophageal Reflux Disease) – Laparoscopic Nissen Fundoplication
• Hiatal Hernia – Laparoscopic Fundoplication or mesh repair
• Achalasia – Laparoscopic Heller Myotomy
• Esophageal Cancer

GERD – Acid Reflux Disease

Occasional heartburn is a normal part of the digestive process such as after a large or particularly heavy meal. Severe and persistent symptoms often indicate GERD, a serious disease in which your stomach acid backs up, or flows back into your esophagus or throat, causing a severe burning sensation in the middle of your chest. This condition occurs when the one-way valve (Lower Esophageal Sphincter) is too weak to function normally. If left untreated GERD can cause painful sores, or ulcers, in the esophagus, and can lead to esophageal bleeding. Chronic irritation of the esophagus can also lead to the growth of abnormal cells in the esophageal lining. This as known as Barretts Esophagus. It has been linked to an increased risk of stomach and esophageal cancer.

Symptoms of GERD can include:

• Frequent heartburn and acid regurgitation
• Chest pain, especially when bending over or lying down
• Difficulty swallowing
• Hoarseness, wheezing, or other asthma-like symptoms
• Chronic coughing
• Sour or bitter taste in the mouth or back of throat

If dietary changes and over the counter antacids don’t control your symptoms, and any other serious medical problems have been ruled out, you may be a candidate for laparoscopic fundoplication surgery. This is known as a Nissen Fundoplication. During this surgery, the upper-curve of your stomach will be wrapped around the outside of your esophagus to re-create the esophageal sphincter. Your existing lower esophageal sphincter is thus strengthened, helping to keep acid down, and allowing the esophagus to recover from any previous inflammation. This surgery usually requires an overnight stay in the hospital.

Achalasia

Achalasia is a condition that occurs when the lower esophageal sphincter is unable to relax and allow food to pass into the stomach. Patients with Achalasia find it difficult to swallow food, sometimes describe a “sticking” feeling in their throat. They experience a heavy sensation in their chest. Achalasia can also cause food regurgitation. If the patient is asleep when this happens, it can cause snoring or even choking, and if the regurgitated food enters the lungs, it can cause pneumonia.

Achalasia can be treated using oral medications, by dilating or stretching the esophagus, injecting muscle-relaxing medications directly into the esophagus (Botox), or through surgery (Laparoscopic Heller Myotomy). The type of surgery used to treat achalasia repairs the lower esophageal sphincter. This surgery usually requires an overnight stay in the hospital.

Hiatal Hernia

Hiatal Hernia occurs when the diaphragm weakens and allows the stomach, or other intestines, to get trapped inside the chest. This can be a life threatening condition if the intestines become blocked. This diaphragm is usually repaired laparoscopically utilizing a mesh with or without wrapping the stomach around itself as described above (laparoscopic Nissen Fundoplication).

Esophageal Cancer

Esophageal cancer occurs when the cells in the wall of the esophagus begin to grow malignant tumors. Esophageal cancer is among the most deadly of all cancers, and has been steadily increasing among Americans in recent decades. Smoking, alcohol use, obesity, poor diet, and chronic acid reflux are risk factors for developing Esophageal Cancer. Currently, surgery is the most common treatment for this Esophageal Cancer. Your surgeon will either remove a portion of the esophagus and surrounding lymph nodes, and upper portion of the stomach. Radiation and chemotherapy may also be used alone or in conjunction with surgery to kill off cancer cells.

Getting Back to Normal

• You will leave the hospital after one to three days, and can return to work in one to two weeks.
• Your doctor will prescribe a liquid diet for a set amount of time, after which you can start eating soft foods. You will still need to chew slowly and thoroughly, avoid gulping, and avoid carbonated beverages for three to four weeks.
• Take it easy upon your return home, avoiding heavy lifting, and vigorous exercise.
• Once you have fully recovered, you will be able to eat, exercise, and engage in all the activities you normally enjoy without the pain and inconvenience that your esophageal disorder once caused.