Surgery of the Esophagus Flashcards
What tissue layer does the Esophagus lack?
SEROSA
Long-standing FB can lead to the developmet of ____ in the esophagus
Strictures
What is the holding layer of the esophagus?
Submucosa
3 Principles of Esophageal SX?
- GENTLE tissue handling
- Minimal tension on suture lines
- Close in either 1 or 2 layers
How do you perform 1 layer closure of the esophagus?
- Simple interrupted suture pattern
- Knots on the EXTRALUMINAL surface
- Encompass all 4 tissue layers
How do you perform 2 layer closure of the Esophagus?
-
1st Layer
- Simple interuppted pattern in mucosa & submucosa
- Knots on INTRALUMINAL surface
- Inner layer will slough off when it heals and be digested
-
2nd Layer
- Simple interuppted pattern in submucosa, muscularis & adventitia
- Prolene or PDS can be used
List the Approaches for Esophageal SX
- Cervical esophagus → ventral midline
- Thoracic esophagus (CRANIAL to <3) → R lateral thoracotomy @ 3rd, 4th, or 5th interspace
- Thoracic esophagus (CAUDAL to <3) s→ R or L lateral thoracotomy @ the 10th, 11th or 12th interspace
- Dorsal recumbency
- Prop behind neck to arch it upwards
- Tie front legs in a caudal direction or cross (if a large dog)
Indications for Esophageal Resection & Anastomosis
- Severe trauma or necrosis
- Esophageal stricture < 3-5 cm
- Esophageal neoplasia (rare in SAs)
What portion of the thoracic esophagus can be safely resected?
up to 1/3
What should you do when resecting > 3-5 cm of esophagus?
Utilize tension relieving techniques
List the layers of the esophagus in the order that they must be sutured close in a Esophageal Resection & Anastomosis
- Seromuscularis (180 degree line)
- Mucosa & Submucosa
- Remnants of mucosa & submucosa
- Finish w/ Front portion of Muscularis layer (go a circle)
What can be used for Esophageal Patching?
- Muscle pedical graft
- sternohyoid mm, sternalthyroid mm., or diaphragm
- Omentum
- Pericardium or gastric wall (on occasion)
Post-op TX for Esophageal SX?
- NPO→ 24 hrs-10 d.
- Liquid diet for 3-5 d. if feeding PO
- Bypass the esophagus (i.e. gastrostomy)
- Slurry via stomach tube
- Thoracostomy tube for 24-48 hrs.
- longer if pleuritits/mediastinitis is present (until negative pressure is regained)
- ABX until drains are removed
Complications of Esophageal SX?
- leakage or rupture along the suture line
- stricture
What factors predispose the Esophagus to rupture post-op?
- LACK OF SEROSA
- Pressure gradient changes due to respiration
- Rapid dilation associated w/ swallowing
List the 4 most common sites of Esophageal Obstruction by FB.
Which 2 sites allow for the easiest retrievel of FBs?
- Thoracic Inlet
- Base of Heart (pull FB back or push FB forward)
- Esophageal hiatus (pushing w/ an endoscope is best)
- Pharyngeal esophagus (not common)
- Pharygneal esophagus or Thoracic inlet
List Radiographic Findings that point towards Esophageal FBs.
- Abnormal intraluminal density
- Esophageal distension
- Tracheal displacement
- Abnormalities of the Mediastinum
- Abnormalities of the Lung fields + pleura
What contrast material should be used if rupture is suspected?
Iodine
Which contrast agents can cause pulmonary edema?
Why?
Iodinated contrast agents
b/c are hyperosmolar
Which 2 methods should be used to remove Esophagel FBs
as much as possible?
- Esophagoscopy
- Balloon catheter retrieval
(Non-surgical techniques)
Post-Op TX for Non-Surgical FB Retrieval?
- No perforation → soft diet + ABX
- Minor perforation → gastrostomy tube feeding + ABX
- Significant perforation → Thoracotomy, Thorascostomy + gastrostomy tube feeding & ABX
Etiology of Esophageal Strictures
- 2° to inflammation & trauma
- Esophageal SX complication
- 2° to Gastroesophageal Reflux Dz (GERD)
- Anesthesia ?
- Antacid TX
Describe the Bouginage or Balloon Dilation
for treating Esophageal Strictures
- Progressively larger dilators are used
- Requires GA
- May require multiple procedures to achieve adequate dilation
- Guarded to fair PX → stricutures often recur
Who most often presents w/ Cricopharyngeal Achalasia?
How do they present?
- puppies at weaning
- problems begin once start eating solid food
- Gagging, retching, forceful expulsion of bolus of food
- Regurgitation immediately after swallowing
DDX for Cricopharyngeal Achalasia
PRAA
Megaesophagus
Pyloric Stenosis
TX for Cricopharyngeal Achalasia
Cricopharyngeal myectomy
(contraindicated for phyaryngeal dyshagia)
What “tool” can help animals suffering from Megaesophagus?
Bailey Chair
(gravity helps food pass to stomach)
What parasite causes granulomatous rxns in the esophagus?
Spirocerca lupi
How can you TX Hypertrophic Osteopathy due to S. lupi?
Surgical removal of a single tumor in the thorax or abdomen → regression of dz in long bones
Where should a Esophagostomy Tube be placed?
Why?
Cranial to the Esophageal Hiatus
Don’t want to cause Gastroesophageal reflux by having the tube too close to the stomach
What should you ALWAYS do when using an Esophagostomy Tube?
Flush w/ water → feed patient→ flush with water
