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23 Cards in this Set
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esophageal procedures
Dilation |
Allows the doctor to stretch or dilate a narrowed area of your esophagus
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Pathophysiology
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-may be indicated in patients who have an esophageal stricture due to: past surgery, chemical or thermal injury, anatomic anomalies
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Diagnostic intervention
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1 upper GI series is required before the procedure to determine the location of the stricture
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This is a clean procedure performed in the OR, endoscopy unit or can be done in the ER (for patients who have retained boluses of food)
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anesthesia
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moderate or general
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instrumentation:
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esophageal bougies (hurtst or maloney are commonly used) ingraduated sizes, gastroscipe with light cord and camra head
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Patient position
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supine
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supplies and equipment:
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lubricant, gauze sponges, and gloves; esophageal stent may be requested; may request fluoroscopy in room
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Prep
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no prep
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procedure
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usually start with the smallest bougie and progressively uses the next in size
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the surgeon may perform a gastroscopy first; then bougies are passed one at a time and inserted firmly but gently to dilate the esophageal lumen
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procedure cont.
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continuation of the dilation of the largest bougie depends on the ease of passage of each bougie and the patients's tolerance
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laser therapy may be indicated if a tumor is causing the stricture-using Nd:YAG* laser and fiber wire
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procedure cont.
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esophageal stent may be placed to decrease chance of recurrence
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Complications:
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esophageal perforation- this would require an open repair
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esophagectomy
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Removal of the esophagus
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pathophysiology
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performed due to esophageal cancer, usually adenocarcinoma or squamous cell
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poor prognosis with these cancers, if treated late
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pathophysiology
50 % of patients with late prognosis ineligible for this surgery because of : |
late stage of disease, debilitating multi system conditions, infection, malnutrition
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Surgical intervention- can be accomplished by several different approaches and procedures:
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transthoracic, transhiatal, video assisted thoracotomy surgery (vats) or laparoscopic assisted approach
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poor prognosis with these cancers if treated late
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patient will eventually go to the ICU
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transthoracic: best approach for this procedure
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removes portion or entire thoracic esophagus through left side thoracoabdominal incision provdies best exposure and is indicated for patients with cardiac and pulmonary disease
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lymph nodes are completely dissected
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2 after incision, chest cavity is opened
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esophagus is dissected fre from the aorta
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diaphragm is opened; stomach is mobilized and ten transected well below the tumor/lesion
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3 closure of stomach is achieved b insteinal suture or linear stapler device
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separate opening is made in the stomach for anastomsis to the esophagus-this end is divided and sutured to the stomach opening
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stomach is anchored to the pleura and diaphragm edges are sutured to the stomach wall
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transhiatal
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removes two-thirds to the entire thoracic esophagus through an upper midline incision (can be laparoscopic) and an incision in the neck above the left clavicle; no thoracotomy
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stomach is shaped into a tubular shape at the greater curvature using surgical staples
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2 tubular stomach segment is tunneled up to the left clavicle incision (gastric-pull-up)
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stomach is reconstructed with an end to end anastomosis
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pyloroplasty is done to incease stomach emptying
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Video-assisted thoracotomy surgery
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ths is done in three stages
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stage one begins with thoracoscopic dissection and mobilization of the esophagus
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