There are multiple diseases of the esophagus for which you may need surgery. Regardless of your condition, the minimally invasive procedures performed at our LA locations entail a short recovery, as well as reduced discomfort and pain.
Nevertheless, before undergoing surgery, your health will be thoroughly assessed by Dr. Marmureanu, who will order a series of tests in this respect. This way, we will make sure we employ the best and lowest-risk approach for your procedure.
Some of the esophageal diseases which may require surgery are:
- esophageal cancer
- Barrett’s esophagus
Before deciding if you are eligible for esophageal surgery, the team of medical professionals at the California Heart & Lung Surgery Center will ask you to go through some of the following tests:
- physical exam – the physician will check your esophagus for signs of the disease such as lumps or any other abnormalities and will also take in consideration your medical history and lifestyle, such as whether you are a smoker
- chest X-ray – a chest X-ray will allow the physician to take a better look at your esophagus and determine the current stage or severity of your disease
- esophagoscopy – this procedure allows the physician to see inside of your esophagus by inserting a thin, flexible tube through your mouth or nose down the throat and examine it for any abnormalities with better accuracy than a chest X-ray, which does not provide such a clear picture
- biopsy – by using the method above, namely esophagoscopy, samples of tissue which will subsequently be examined by a pathologist can be taken with special medical instruments
- esophageal pH monitoring – a test which measures how often and for how long gastric acid enters the esophagus from the stomach, performed by inserting a catheter with a sensor attached down to the end of your esophagus
- Bravo Capsule pH monitoring – a new, catheter-free test which involves swallowing a pill which collects data regarding your esophageal pH and transmits it via radio waves to a small external device worn by the patient
- upper endoscopy – allowing the physician to closely examine your esophagus, stomach, and duodenum, this test is performed by inserting a small tube through your mouth, which provides clear, high-quality images of the inside of your body to the doctor overlooking the procedure
- endoscopic ultrasound – also known as endosonography, this procedure entails a thin tube – endoscope - which emits high-energy sound waves being threaded through your mouth to detect any abnormalities
- CT scan – a CT scan will show high-quality images taken from different angles from the inside of your body so that the physician can accurately assess the severity of your disease and determine where the problematic areas are located
After your esophagus and surrounding areas are thoroughly evaluated, the most effective type of surgery will be recommended to you, for which you need to prepare by starting walking every day, eating a balanced diet and quitting smoking a few weeks prior to the procedure, regardless of the approach. Furthermore, 2 days before the date of your surgery, you will be required to drink only clear liquids - 6-8 glasses per day - to stay hydrated. Solid food, dairy products, and alcohol are strictly forbidden during this period.
Bowel preparation is also important. For this, you will have to buy 2 bottles of magnesium citrate of 10 oz. each from the pharmacy. You should drink the magnesium citrate 2 days before the surgery, in the morning. As is the case with any surgery, you must not eat or drink anything after midnight the night before the surgery.
Our Locations in Los Angeles
This type of surgery is employed for esophageal cancer and involves the surgeon making incisions in your abdomen and chest or abdomen and neck to reach the organ. He will carefully remove the malignant tumors and rebuilt your esophagus so that you will be able to eat normally following the procedure. However, open esophagectomy may also be required for other conditions, such as trauma to the esophagus, swallowing of caustic agents such as lye, chronic inflammation or a muscle disorder which prevents the movement of the food you swallow to the stomach.
There are 3 approaches to open esophagectomy, as follows:
- Transthoracic Esophagectomy – This procedure is performed through the chest. Dr. Alexander Marmureanu removes the malignant tumors and, if necessary, a part of the esophagus, and subsequently rebuilds it, sometimes using a part of your colon.
- Transhiatal Esophagectomy – During this surgery, the esophagus is removed without opening the chest. The incision will be made from the bottom of the breastbone to the belly button, while another one will be made on the left side of the neck. Dr. Marmureanu will remove the esophagus, place the stomach up to the area in the neck where the esophagus was removed and connect the remaining portion to the stomach in the neck. If the surgery is performed for removing malignant tumors, the affected lymph nodes in the neck and chest will be resected as well.
- En Bloc Esophagectomy – As the most radical type of open surgery, en bloc esophagectomy entails removing the esophagus, a portion of the stomach and all of the lymph nodes in the chest and abdomen. It is performed through incisions in the neck, chest, and abdomen. In the end, Dr. Alexander Marmureanu reshapes what is left of the stomach and brings it up through the chest to replace the esophagus.
Minimally Invasive Esophagectomy
When the problematic area of the esophagus is small, a minimally invasive approach will be suitable. It involves several small incisions and it is performed using a laparoscope – a thin tube equipped with a camera and the necessary medical instruments – to remove the affected portions of the esophagus. The benefits of this type of surgery are numerous, from more rapid recovery time to less pain and discomfort following the procedure.
Depending on the complexity of your problem, esophageal surgery may take 6 to 8 hours to complete. Following surgery, Dr. Alexander Marmureanu will provide you with instructions regarding how to take care of yourself within the next few months.