Surgery for the Esophagus

For reflux, cancer, perforation or other conditions

Working in coordination with Aria’s respected Division of Gastroenterology, Aria’s general surgeons and thoracic surgeons can offer various surgical procedures to treat conditions of the esophagus – the muscular tube that connects the back of the throat with the top of the stomach.  The procedures address these

esophageal disorders:

- gastroesophageal reflux disease (GERD).  Sometimes this condition is caused by a flaccid sphincter muscle and lax connection at the juncture of the esophagus and the stomach.  As a result, acidic stomach juices leak into the bottom of the esophagus.  Surgery for severeacid reflux involves restructuring and tightening the area where the esophagus enters the stomach. Aria specialists can often use a laparoscope to perform this operation endoscopically, with minimal invasiveness.  This approach requires several small incisions in the abdomen.  (However, if laparoscopy is not feasible, open surgery using an incision in the left side of the chest may be necessary.)  In the operation, the surgeons wrap an upper portion of the stomach around the base of the esophagus, reinforcing the valve structure in his area by creating a kind of collar around it (a procedure called Nissen fundoplication).  This operation may be combined with repair of hiatal hernia.  Normally, patients stay just one night in the hospital to recover before returning home to complete their recovery from this surgery.

The operation so successful in relieving GERD in the vast majority of cases, that most patients no longer need reflux medications.  (Note, though, that some patients will experience recurrence of reflux some years later.)  Patients with significant damage to the esophagus or stomach, related to reflux – such as ulceration or scarring – may need more extensive surgery, involving removal of compromised tissue, to correct these conditions at the same time.  Some patients also come for revision or repair of previous reflux operations performed at other centers.

- esophageal narrowing or obstruction.  Strictures of the esophagus can be caused by abnormal growths or malignancies, anatomical deformations, or even severereflux disease.  They can cause difficulty in swallowing and can obstruct food passage into the stomach.  Using endoscopy, surgical specialists can place special tubes called stents across the compromised area of the esophagus to expand its opening.  These stents, usually made of fine wire mesh, are left behind and remain in place to maintain the opening of the esophagus.  The team will sometimes combine this step with laser surgery to remove tissue intruding on the esophageal opening.  Stents must sometimes be replaced in order reposition them or reestablish them.  These stents most often serve as palliative treatment for esophageal cancer.

- esophageal motility disorders, such as achalasia.  In these conditions, the esophagus lacks the muscular contractions in its lower half necessary to move food adequately into the stomach.  In addition, the valve at the bottom of the esophagus, just above the juncture of the stomach, fails to open to allow food to enter the stomach.  This condition will worsen if left treated.  Specialists recommend some patients for endoscopic treatment via the esophagus itself, but a substantial portion will need surgery, which provides more dependable relief of the condition.  In this well-established operation, called a minimally invasive esophageal myotomy, the surgeon cuts the thickened muscles of the valve between the esophagus and stomach.  This allows passage of food and can be performed laparoscopically through several small slits made in the abdomen.  Usually, the surgeon will also perform at least a partial stomach wrap around the site (as in GERD treatment) to minimize reflux through the newly opened sphincter area.  Patients who receive this surgery laparoscopically will typically need to stay one to two days in the hospital.  Those who undergo the procedure through conventional, open surgery (through an incision in the chest or abdomen) will need up to one week in the hospital

- esophageal cancer.   While not among the most common malignancies, esophageal cancer is on the rise.  It is most common in patients who suffer from a severe form of GERD called Barrett’s esophagus.  To learn more about surgery for cancer of the esophagus, see Aria’s Division of Surgical Oncology.

- esophageal perforation.  Sometimes the esophagus may be inadvertently punctured as a result of a diagnostic or surgical procedure.  Such a hole in the esophagus is a serious complication, but specialists can repair it by placing an esophageal stent across the compromised area of esophagus.  The stent remains in place while the perforation heals and is then removed, sparing the patient from having to undergo surgery to repair such perforations.

Aria’s general surgeons work in coordination with other specialists and with their patient’s referring or family physician when providing surgery for esophageal conditions.