Esophagectomy

When esophagectomy is the complete surgical removal of the gullet (esophagus ). The surgical removal of part of the esophagus is called esophageal resection.

Indications

Both benign ( motility = movement disorders of the esophagus, such as achalasia ) and malignancies ( esophageal cancer ) may require surgical removal of the esophagus. If it is an intervention in cancer disease, one also speaks of a radical esophagectomy. Here, the esophagus with adjacent lymph nodes removed ( lymphadenectomy ).

Molding

There are different forms of this procedure. On one hand, the engagement with the opening of the thoracic cavity may ( thoracotomy ) carried (so-called transthoracic esophagectomy ). On the other hand, the esophagus can be removed from the abdomen dull from ( laparotomy ) through the diaphragm ("stripping ", transhiatal esophagectomy ).

Reconstruction / restoration of the supply passage

To restore the passage of food after esophagectomy, the stomach may be formed into a replacement esophagus and connected to the upper esophageal stump (so-called stomach pull-up ). Another possibility consists in the intermediate circuit ( interposition ) of a part of the large intestine ( the so-called colon intermediate circuit Koloninterposition ).

Risks and Complications

The esophagectomy is one of the larger visceralchirurgischen operations and involve a variety of specific possible complications. Here the most important:

  • Hemorrhage: The topographical proximity to the great vessels, and difficulties accessing carry the risk of severe intra-and postoperative bleeding.
  • Anastomotic leak: the " rising" of the seam connection between the raised stomach or colon part can lead to serious, life-threatening infections. These are even more manageable than in intrathoracic Anatomose in esophageal partial resection at collarer ( lying at the neck ) anastomosis. In this case threatens the life-threatening mediastinitis ( mediastinal inflammation).
  • Anastomosis: A cicatricial contraction the anastomosis at risk the continuity of the anastomosis and prevents oral nutrition.
  • Aspiration pneumonia: The lack of sphincter function can lead to an uncontrollable flow back ( reflux ) of food consumed and an aspiration to a dangerous pneumonia ( pneumonia).
  • Peritonitis: the insufficiency of the lower anastomosis in Koloninterposition can lead to life-threatening peritonitis.

Sample size dependence of the results

The dependence of the results of esophagectomy of the case number (number of hospital procedures performed per year ) is occupied. To die in hospitals with <2 procedures per year, approximately 18% of patients, whereas the Eingriffsletalität may be less than 5% in major centers.

Swell

  • J. R. Siewert, Surgery, 7th edition, Springer-Verlag, ISBN 3540674098
  • Siewert JR, Bartels H, Stein HJ. Abdomino -right- thoracic esophagectomy with intrathoracic anastomosis in Barrett 's cancer. Surgeon. June 2005, 76 (6 ) :588 -94. PMID 15875146
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