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A transhiatal esophagectomy is a surgical procedure used to remove a cancerous or severely damaged esophagus. The operation involves cutting out most of the lower esophagus and uppermost portion of the stomach, and then suturing the remaining structures together to preserve digestive tract functioning. Most people who undergo transhiatal esophagectomy experience near full relief from their previous health problems. There are important risks involved, such as ongoing digestive symptoms and bleeding issues, but modern surgical techniques and careful post-operative monitoring allow the majority of patients to recover without complications.
The esophagus and stomach meet at an opening in the diaphragm muscle called the hiatus. Transhiatal esophagectomy is performed through the hiatus via a small opening in the abdominal cavity. There are other forms of esophagectomy that involve opening the chest cavity, but most professionals prefer the transhiatal approach to avoid damaging bone and exposing delicate organs such as the heart.
Most hospitals and clinics have the technology available to perform laparoscopic transhiatal esophagectomy. A series of three to four small incisions are made in the upper abdomen and a fiber optic endoscope is inserted to guide the surgery. Forceps, clamps, and scalpels are manipulated through the incisions to clip off the top of the stomach. Another small cut is made in the neck to detach the esophagus. The esophagus is then gently pulled through the hiatus and out of an abdominal incision.
Once the esophagus is removed, the surgeon pulls the stomach upward and connects it to the remaining portion of the esophagus with specialized stitches and glues. After a thorough inspection with the endoscope to make sure everything is in place, instruments are removed and the surgical wounds are closed. Transhiatal esophagectomy can usually be completed in about one hour.
A patient typically needs to stay in the hospital for at least five days following transhiatal esophagectomy so health-care workers can monitor recovery and treat surgical wounds. Consuming a specialized diet consisting mainly of liquids and very soft foods such as yogurt is important during the first few weeks after surgery. Patients are typically prescribed pain medications and scheduled for several checkups in the following months. When the procedure is successful, a person can usually begin eating and exercising normally in about three months.
A small number of patients experience complications following surgery. If digestive problems such as food regurgitation, stomach cramps, and nausea occur, a person may need to adjust his or her diet and take medications. Hemorrhaging inside the neck is uncommon but may cause significant complications. In most cases, doctors are able to limit risks and address small problems before they become major issues during routine physical exams.