Prior to surgery - Evaluation usually includes blood work, a chest x-ray, endoscopy with ultrasound, CT scan, and evaluation by an anesthesiologist. If the surgeon plans to use colon to replace your esophagus, you will have to endure a bowel prep and maintain a liquid diet 2 days before the surgery.
Do not eat or drink after midnight before your scheduled surgery. You will be able to take your regular medications with a sip of water. You will be notified by the Surgery Center of what time to check in for your surgery.
The day of surgery - In preparation for surgery, you will change into a hospital gown, and a catheter will be placed in your arm for medication. After you meet with your surgeon and anesthesiologist, you will be taken to the operating room on a stretcher. You will receive some relaxing medicine, and an epidural catheter will be placed in your back. This will be connected to tubing after surgery, to deliver pain medicine.
You will awaken in the recovery room, where your blood pressure, heart rate, temperature, breathing, and pain control will be closely monitored. You may notice a tube in the side of your chest, and a chest x-ray is usually taken. Additionally, you will have a tube in your bladder to collect your urine, a tube through your nose into your stomach to prevent nausea and vomiting, and possibly a breathing tube in place. You will also have a small drain in your neck.
Recovery - Initially you will be in the intensive care unit (ICU), and transferred to the floor 1-2 days later. The breathing tube is normally removed within 24 hours of surgery. The various tubes will be removed 1-4 days after surgery. You will not be allowed to eat or drink for 5-7 days after the surgery; however, you will be fed through a tube in your abdomen for nutritional support. You will be connected to a monitor to follow your heart rate and rhythm.
The morning after surgery, members of the thoracic surgery team will help you get out of bed to sit in the chair and walk. You will work with the respiratory therapists on breathing exercises. A swallow study, in which you drink contrast material while x-ray pictures are taken, will be done 5 to 7 days after surgery to determine if there is an anastomotic leak. If there is no leak, you will be allowed to drink clear liquids and the drain in your neck will be removed. If there is a leak, you will not be allowed to eat. Depending on the severity of the leak, you may have a stent placed in your esophagus, require additional surgery, or be allowed to heal the area on its own.
You should expect to spend 1 -2 days in the ICU, and a
total of 7 to 10 days in the hospital. Before going home you will need to
understand any wound care issues, medication changes, tube feeding schedules,
and activity restrictions. After discharge, you will see your surgeon in
the office in one week.
