Esophageal Surgery Flashcards
How does the esophagus of dogs and cats compare?
DOGS - entirely skeletal muscle
CATS - skeletal muscle, then smooth muscle
What are the 5 most common clinical signs of esophageal disease?
- regurgitation
- dysphagia
- salivation
- coughing
- dyspnea
What is the difference between vomiting and regurgitation?
VOMITING = nausea and retching with the presence of digested food or bile, acidic/alkali, and within anytime after feeding
REGURGITATION = no nausea or retching with the present of undigested food and no bile, alkali, and often related to feeding
What makes dehiscence common in the esophagus?
- lack of a serosal layer
- thick mucosa
- presence of saliva and continual motion
- no omentum
What is the holding layer in the esophagus for surgery? What is the vascular supply?
submucosa
submucosal plexus and segmental extrnisic vasculature
What are the 2 ways of closing the esophagus following an incision? What suture is commonly used?
ONE LAYER CLOSURE - simple interrupted knots tied on the extraluminal surface
TWO LAYER CLOSURE - simple inverted interrupted in the mucosa and submucosa and simple interrupted in submucosa, muscularis and adventitia
typically prolene, but PDS can be used
What are the 3 approaches to esophageal surgery?
- cervical - ventral midline, displace esophagus to the right
- thoracic cranial to the heart - LEFT by the 3rd-5th interspace
- thoracic caudal to heart - right or LEFT by the 9th-11th interspace
- right at heart base = right
Left vs right thoracotomy:
How can the esophagus be made more obvious for surgeries? What body part must be carefully avoided?
pass an orogastric tube
thyroid and recurrent laryngeal nerves
How can the esophagus be stabilized during esophagotomy? What should be done after the procedure?
place stay sutures
flush after removal and asses that there is no further damage
In what 3 situations are esophageal resections and anastomoses indicated?
- severe trauma or necrosis
- esophageal stricture > 3-5 cm in length that is not successfully treated by bouginage
- esophageal neoplasia (rare in dogs and cats)
How much of the thoracic esophagus can be resected? What should be done if more is required?
1/3 of the esophagus
resection more than 3-5 cm require tension relieving techniques
In what order is the esophagus closed for esophageal resection and anastomosis?
360 mucosa closure - adventitia and muscularis sutured first and then mucosa and submucosa
Esophageal resection and anastomosis:
In what 2 ways can tension be relieved during esophageal resection and anastomosis?
- partial myotomy where a circumferential incision through longitudinal muscle layer 2-3 cm cranial and caudal to the site
- cranial mobilization of stomach
When is esophageal patching indicated? What are 3 possible body parts that can be used?
reinforcement of esophagotomy or esophagectomy site
- muscle pedicle graft from sternohyoid, sternothyroid, or diaphragm
- omentum
- pericardium or gastric wall
How should patients be fed following esophageal surgery?
NPO for 24 hours to 10 days or a liquid diet for 3-5 days
- may need to bypass esophagus
How long should a thoracostomy tube be left following esophageal surgery? How long are antibiotics used?
24-48 hours, but longer if pleuritis/mediastinitis is present
until drains or removed, longer if infection is present
What are the most common complications of esophageal surgery? What 3 factors predispose?
leakage or rupture at suture line or stricture
- lack of serosa and omentum
- pressure gradient across esophageal wall caused by changes in pleural pressure with breathing (constant motion)
- rapid dilatation associated with swallowing
What are the 4 most common sites of esophageal foreign body obstruction?
- pharynx/esophagus
- thoracic inlet
- base of heart
- esophagus hiatus
What are the 4 most common clinical signs of esophageal foreign bodies?
- dysphagia, choking, coughing
- regurgitation
- refusal to eat
- depression and pyrexia
What are the 5 most common radiographic findings on survey radiographs with esophageal foreign bodies?
- abnormal intraluminal density
- esophageal distention (dilated)
- tracheal displacement
- abnormalities of mediastinum
- abnormalities of lung fields +/- pleura
What is the treatment for esophageal foreign bodies? What must be done after?
removal
assess integrity of esophagus by endoscopy and contrast radiography and surgically repair if necessary
How does morbidity and mortality rate for esophageal foreign bodies removal by esophagotomy vs endoscopy compare?
morbidity and mortality rates are higher via esophagotomy, so non-surgical means of removal should be used whenever possible
(however, large or heavy FBs may be impossible to remove with endoscope or balloon catheter)
