Esophageal Surgery
The esophagus is the
muscular tube through food passes from the mouth and pharynx to the
stomach. The esophagus courses through the center of the chest near
the back bone behind the wind pipe and heart on its way to the abdomen,
where it attaches to the stomach. Two or three inches of the end of
the esophagus resides in the abdomen. The most common problems of the
esophagus that warrent medical attention involve this abdominal portion
of the esophagus as it connects to the stomach. Heartburn or gastro-esophageal
reflux disease (GERD) can usually be treated medically, but, on occasion,
surgical treatment is required. This is true for medically intractable
symptoms of GERD or complications such as esophageal stricture caused
by acid reflux. Although strictures can usually be dilated as an outpatient
procedure using a scope, a rare number will require surgical correction.
More commonly, reflux symptoms not effectively treated with medicine,
can be corrected surgically. Other conditions of the esophagus which
require surgical tratment include certain types of hiatus hernias and
tumors of the esophagus, both benign and malignant.
The picture to the
right demonstrates a long area of obstruction in the esophagus shown
by an x-ray examination known as a barium swallow. In this test the
patient drinks liquid barium, which shows up as the densely white column
of dye in the picture. The barium would normally pass all the way through
to the stomach, but here its passage is obstructed. A patient with this
type of obstruction would have progressive problems with swallowing.
At first he or she would not be able to easily swallow meat, with a
feeling that food "sticks" somewhere in the chest. This uncomfortable
or painful sensation may be relieved by swallowing liquids or by vomiting.
With higher degrees of obstruction, even liquids would "stick."
Finally, the patient would not even be able to swallow his or her own
saliva and may chronically choke on food or secretions. Patients often
have repeated bouts of pneumonia because of this. They frequently lose
weight because they can not get food into the stomach and intestines
to use calories to maintain weight. A biopsy is required to determine
whether this is a cancer of the esophagus. This type of cancer can be
treated with chemotherapy, radiation therapy, surgery, or a combination
of these three options. Cancer of the esophagus is notoriously difficult
to diagnose in its early stages, so cures are infrequent no matter what
type of therapy is used. The most important goal of surgery for cancer
of the esophagus is to re-establish the ability of the patient to swallow
food without the symptoms of obstruction.