Esophagus Disorders

• Esophageal duplication cysts are growths in the esophagus
• Minimally invasive (laparoscopic) surgery can be performed to remove the cysts

• Esophagectomy is the removal of all or part of the esophagus where cancer is present
• After the esophagus, or part of it, is removed, the esophagus is rebuilt from part of the stomach or large intestine
  • In open surgery, one or more large incisions are made in the belly, chest, or neck
  • In laparoscopic (minimally invasive) surgery, several small incisions are made in the belly, chest, or neck. A thin tube and tiny camera (laparoscope) and surgical tools are inserted into the incisions to perform the surgery
• Length of stay is about one week and the UI complications rates are extremely low due to our surgical expertise and team approach.

• Esophageal perforation is a hole in the esophagus
• A perforation in the upper part of the esophagus near the neck may heal on its own
• Surgery is typically needed to repair a perforation in the middle or lower part of the esophagus

• Esophageal stricture (narrowing the esophagus) causes problems with swallowing
• Treatment involves dilation (opening) of the esophagus using a balloon dilator passed through an endoscope (a flexible tube passed through the mouth)

• Treats acid reflux, also known as GERD (gastroesophageal reflux disease)
  • GERD is when stomach acid comes back up from the stomach into the esophagus (the tube that runs from the mouth to the stomach)
• Fundoplication is the most common type of anti-reflux procedure. This involves wrapping part of the stomach around the end of the esophagus with stitches:
  • Open surgery
    • One large incision in the belly
  • Laparoscopic (minimally invasive) surgery
    • Three to five small incisions, with a thin tube and tiny camera (laparoscope) inserted into one of the incisions
    • The camera is connected to a video monitor in the operating room
    • Surgical tools are inserted into the other incisions
    • The surgeon does the repair using the video monitor to view the inside of the belly

• Achalasia is a disorder in which the esophagus cannot move food into the stomach. It occurs when a muscular ring where the esophagus and stomach meet (the esophageal sphincter) does not relax like it should during swallowing.
• A Heller myotomy is a laparoscopic (minimally invasive) procedure that involves cutting the affected muscles in the esophagus and stomach.
  • Makes it easier for food to reach the stomach

• Uses an endoscope inserted into the esophagus
• A tiny blade passes through the endoscope, making a small slit in the lining of the esophagus
  • To carefully divide the muscle that is restricting the passage of food to the stomach

• Occurs when part of the stomach pushes upward through the diaphragm into the chest
• Repair involves tightening the opening in the diaphragm with stitches to keep the stomach from pushing upward

In most cases, a less invasive approach is an option for patients with esophageal disease such as

• Barrett’s Esophagus 
• Hiatal (abdominal) hernias
• Severe acid reflux, also called GERD

UI thoracic surgeons have the most experience in the state dealing with esophageal issues and are trained in a number of approaches, including a procedure to treat GERD called Laparascopic Nissen Fundoplication. Our surgical team even offers a surgery that doesn’t have an incision, called Transoral Incisionless Fundoplication (TIF), or Endoluminal Fundoplication. Several tests are indicated to help determine if surgery is required for this condition:

• 24 hour PH probe (off anti-reflux medications for 3 days before the test) to evaluate the extent of period of time reflux occurs
• Esophagram: Outline the anatomy of the esophagus
• Endoscopy with biopsies: Evaluate the inside tissue lining of the esophagus
• Esophageal Manometry: Assess for motility or muscle disorders in the esophagus
• Fluoroscopy