Esophagectomy surgery: Don't be afraid of this, let's talk about everything simply!

It's normal to feel a little scared and nervous when your doctor tells you or someone close to you that you need to have an operation called "Esophagectomy." You may have many questions like, "What is this operation? Why is it being done? What will happen after that?" But don't worry. We will talk about everything in simple Sinhala that you can understand, very friendly. By the time you finish reading this article, you will have a good understanding of this.

Simply put, what is Esophagectomy?

An esophagectomy is a surgical procedure that removes part or all of your esophagus. The esophagus is the tube that carries food and drink from the throat to the stomach. It's like a water pipe.

Now you may be wondering, "Why is this being removed?" The main reason is esophageal cancer . Doctors also recommend this surgery in cases where you have conditions like Barrett's esophagus, which increases your risk of cancer, or when your esophagus is not working properly and you have difficulty swallowing.

During surgery, the surgeon removes the damaged part of your esophagus. If it is cancer, some of the nearby lymph nodes are also removed and sent for testing. Then, the remaining parts are reconnected and your food pipe is restored. This means that the stomach is pulled up a little and connected to the rest of your esophagus. This way, your food pipe is repaired so that you can eat normally again.

What are the different methods of performing this surgery?

Although all esophagectomy procedures involve removing the esophagus, the method your surgeon uses can vary depending on factors such as the location of your tumor or damage and your overall health.

There are mainly two methods:

• Open Surgery: Here, a single long incision is made in the skin to reach the esophagus.
• Minimally Invasive Surgery: This is what we call "laparoscopic surgery." Instead of one large incision, several small incisions about an inch long are used to perform the surgery, through which a camera and instruments are inserted. Surgery to access the abdominal organs is called `Laparoscopic surgery`, and surgery to access the chest organs is called `Thoracoscopic surgery`.

There are several types of surgeries based on these methods. The table below explains more about them.

How do we prepare for such a major surgery?

Esophagectomy is a major surgery, and it takes some time to recover. Therefore, it is very important that you prepare well before the surgery.

• Various tests: To plan the surgery, your doctor will order tests such as a CT scan of your chest and abdomen, an Endoscopic ultrasound (EUS), or a PET scan.
• Getting initial treatment: If you have cancer, you may need to have chemotherapy and/or radiation therapy before surgery. Some people get better results from getting these treatments earlier.
• Preparing your body for surgery: If you have conditions like diabetes or high blood pressure, you need to get them under control before surgery. If you smoke, you should definitely quit. Smoking significantly delays the healing process.
• Preparing for the recovery period: Since your eating habits will change after surgery, you can seek advice from a dietitian . You can also learn from a speech-language pathologist (SLP) about exercises to strengthen your breathing muscles to prevent lung complications after surgery.
• Preparing for Hospitalization: Since you will be in the hospital for a week or two, prepare the necessary clothing, medications, and things like a book or pillow that will bring you comfort.
• After you get home: Arrange for someone to come home from the hospital. It's also important to have someone to help you at home. Arrange your home so that you can easily get the things you need.

What happens during the surgery?

Before the surgery, you will be given anesthesia so that you will not feel any pain. This means that you will be completely asleep. After the surgery, you may also have an epidural tube placed in your back to control the pain.

The surgeon makes incisions according to the procedure and removes the diseased part of the esophagus. Sometimes a small part of the stomach may also be removed. Then, the stomach or small intestine is brought into the chest area and connected to the rest of the esophagus.

After surgery, a feeding tube will be placed into your stomach or small intestine to provide nutrition until you can swallow. A nasogastric tube will also be placed through your nose to help remove excess air from your stomach and help you recover. Chest drains may also be placed to drain fluid from your chest. All of this is done to help you recover faster. The surgery usually takes between 3 and 6 hours.

What will happen after the surgery?

After surgery, you will be kept in the intensive care unit (ICU) for a day or two. You will be started on a feeding tube. You will be given medication to control the pain. You may have to stay in the hospital for about two weeks.

While in the hospital,

• You will be told to wear compression stockings and walk to prevent blood clots .
• You have to do breathing exercises to keep your lungs clean.
• You will be taught how to keep the feeding tube and wound clean.

What are the side effects and risks?

Any surgery can cause some side effects, and it's important to be aware of the risks.

Most of these symptoms will subside as you recover, but if you have any concerns, contact your doctor immediately.

When should I call the doctor or go to the hospital?

Some problems may arise during the recovery period. If you have any of the following symptoms, inform your doctor immediately.

• If the pain or fever increases
• If the area around the incision is red and feels hot
• If the body becomes weak
• If you have difficulty breathing or your chest is pounding
• If the stomach is loose or the stool is black
• If you have a sore throat
• If you have a persistent cough
• If the whites of the eyes or skin turn yellow (Jaundice)
• If you have difficulty swallowing or continue to lose weight

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