Dr. C.Prashanth

Esophagectomy is a procedure of removing a part of the esophagus and reconstructing the same using another organ of the body. The oesophagus is the tube that connects the stomach and the mouth. This procedure is often performed in an advanced stage of esophageal cancer and Barrett’s esophagus. This procedure removes the cancer cells from the esophagus and gives relief from the symptoms. The organs from where the reconstructing tissues are taken are generally large intestine and stomach.

Many esophagectomy surgeries are performed with minimally invasive techniques. The latter is commonly known as laparoscopic surgery. This is a procedure where numerous small incisions are made in order to perform the surgery. This procedure results in faster recovery and reduced pain as compared to the conventional surgery.

Newer methods such as Robotic surgery are being adopted by many doctors these days. Procedures like these can access the oesophagus through places such as the throat, collarbone and abdomen. They make a minute incision to get to the exact location of the cancer and treat them with an improved precision, unlike the conventional surgical methods.

An important aspect of treating this condition is to determine the procedure that is going to be implemented. To determine this, doctors uses imaging techniques such as PET scan, CT scan and an MRI scan. A doctor might also prescribe other tests such as FNAC and endoscopic ultrasound. Heart evaluations are also conducted before the surgery to ensure that there are no complications involved while performing the surgery.

Before Esophagectomy

Unless the cancer is detected at a very early stage, most doctors recommend radiation or chemotherapy or both. These treatments help to shrink the size of the cancer and make for an effective oesophagectomy. Both chemotherapy and radiation have their set of side effects, which include loss of appetite, fatigue, hair loss, vomiting and skin discolouration.

After Esophagectomy

Post the procedure, a patient cannot directly consume food. He is required to consume food through a pipe for a duration of four-six weeks. Adequate nutrition is required during this phase to recover quickly. Once the patient is able to resume a normal diet, it should be ensured that he takes food in reduced quantities to make up for the reduced stomach size.

Follow-up

Almost 90% of patients who have gone through this procedure report an improved life quality. While lifestyle related adjustments have to be made, there could be regular follow-ups to ensure the below mentioned complications do not arise:

1. Breathing-related problems

2. Swallowing problem

3. Effectively managing heartburn and ensuring the pain is under control

4. A thorough review of the nutritional diet to be consumed by the patient to counter sudden weight loss.

Any surgery that requires an incision will involve sutures or staples as the last step of the procedure. This helps close the incision and keep out infections. Taking care of your stitches can help limit scarring and discomfort and speed up the healing process. Here are a few things to keep in mind.

1. Keep it clean and dry: For the first few days, use a washed wet cloth to clean the incision site. After a few days, you may start washing the area with soap and water unless advised else wise by your doctor. Ensure that you dry the skin thoroughly after washing it. Avoid baths that involve soaking the area in water. Also, avoid swimming. Do not use any powders, lotions, creams, deodorants etc on the wound site.
2. Look out for signs of infections: Avoid activities that may involve exposing your wound to dirty water, chemicals, dust etc. This increases your risk of infections. Also look out for signs f infections such as redness, swelling, pus or bleeding, fever or increased pain from the wound. In case you notice such signs, consult your doctor at the earliest.
3. Do not scratch: As it heals, your skin is likely to turn itchy. However, refrain from scratching so as to reduce chances of infections. Do not try and pull away from the scab but let it fall off on its own. This will also help limit scarring.
4. Limit contact: Avoid wearing tight clothes or anything that sticks to the skin while your wound is healing. Instead have plenty of loose, comfortable clothes easily accessible. Also, do not take part in close contact sports such as football etc until the stitches have healed completely.
5. Change your dressing regularly: A dressing should be changed as soon as it gets wet or soaked with blood or other body fluids. Wear clean medical gloves while changing a dressing. When putting on a new dressing do not touch the inside of the dressing or apply any creams on the stitches unless advised so by your doctor. In the case of removable stitches, the doctor will usually remove the stitches after a few days. DO not attempt to pull the stitches out on your own.
6. Avoid exposing the wound to sunlight: New skin that forms as the incision heals is very sensitive to sunlight and gets sunburnt very easily. Limiting your exposure to sunlight can help reduce the effects of scarring.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Thyroid is a small butterfly shaped gland, which  is present at the lower frontal region of the neck, right beneath the voice box. It produces hormones which regulate metabolism (the breakdown of food by the body to convert it into energy). It even plays a pivotal role in boosting organ functions as well as in helping the body to sustain heat. However, too much of hormone production by the thyroid gland might yield structural problems, for instance, growth of nodules (abnormal tissue growth) or cysts (non-cancerous sac-like structures containing fluid) and swelling. Hence, a thyroid surgery is a must once these problems occur. The surgery, administered with general anesthesia, eliminates the thyroid gland either wholly or partially.

Why do you need surgery?

1. The presence of tumors or nodules on one’s thyroid gland is one of the reasons why one should go for the surgery. Although most of the nodules are benign, few can be pre-cancerous or cancerous too. Also, those benign nodules can spell trouble, if they expand in size, thus obstructing the throat. They can be problematic as well if they cause the thyroid gland to overproduce hormones, giving rise to a condition known as hyperthyroidism.
2. Hyperthyroidism can be corrected through surgery. It is often an outcome of Grave’s disease, an autoimmune disorder wherein the body misidentifies the thyroid gland as a foreign body, thereby creating antibodies to combat it. The thyroid gland gets inflamed in the process, resulting in the overproduction of hormones.
3. Another reason is the enlargement or swelling up of the thyroid gland, termed as goiter. Similar to large nodules, goiter too can clog the throat, thus interfering with one’s breathing, speaking and eating.

Types of Surgery

1. Lobectomy: This procedure calls for partial removal of the lobes when a nodule or an inflammation affects just half of the thyroid gland.
2. Subtotal Thyroidectomy: Here, a small proportion of the thyroid tissue is left behind even after the elimination of the thyroid gland.
3. Total Thyroidectomy: Through this procedure, the entire thyroid gland is taken out along with the thyroid tissue. If you wish to discuss about any specific problem, you can consult a General Surgeon.

Adverse respiratory events (AREs) are leading causes of post-operative morbidity and mortality. Anesthesia is the use of medicine to prevent or reduce the feeling of pain or sensation during surgery or other painful procedures (such as getting stitches). Giving as an injection or through inhaled gases or vapours, different types of anesthesia affect the nervous system in various ways by blocking nerve impulses and, therefore, pain.

Anesthesia can help control your breathing, blood pressure, blood flow, and heart rate. It may be used to:

1. Relax you,
2. Block pain,
3. Make you sleepy or forgetful,
4. Make you unconscious for your surgery.

Adverse Respiratory Events (ARE)
Adverse outcomes of such events are fatal and lead to Death & Brain Damage. Three mechanisms of injury are reported to account for highest adverse respiratory events:
Inadequate Ventilation: Insufficient Gas Exchange can produce the adverse outcome. Esophageal Intubation: Incubation between the two sides of the esophagus inadvertently.
Difficult tracheal intubation: Tracheal Intubation is the placement of a flexible plastic tube into the trachea (windpipe) to maintain an open airway. It is performed facilitate ventilation of lungs in severely ill, anesthetized patients.

Other’s are as listed below:

• Airway Obstruction
• Inadequate inspired oxygen delivery
• Aspiration
• Endobronchial Intubation
• Premature Extubation

Residual neuromuscular blockade is an important postoperative complication associated to the use of neuromuscular blocking drugs and is commonly observed in the post-anesthesia care unit (PACU) after non-depolarizing neuromuscular blocking agents (NMBAs) are administered intra-operatively. Incomplete neuromuscular recovery can be minimized with acceleromyography monitoring. The risk of adverse respiratory events during early recovery from anesthesia can be reduced by intra-operative acceleromyography use.

Reintubation is a serious adverse respiratory event and the consequences include increased cardiac and respiratory complications, prolonged length of stay at the PACU, intensive care unit (ICU) and hospital, prolonged mechanical ventilator support, higher costs, and increased mortality. Overweight and obesity have also been identified as risk factors for postoperative respiratory complications. Most adverse respiratory events are considered preventable with improved monitoring such as:

• Pulse Oximetry
• Capnometry
• Combination of Both

Closed observation of the clinical factors and appropriate monitoring by well trained people are factors necessary to prevent adverse outcome. If you wish to discuss about any specific problem, you can consult a General Surgeon.

Hernias are mostly treated by surgeries as definitive care. Post-operative period has become comfortable with the invention of minimal-invasive surgeries. Postoperative recovery is smoother and faster after laparoscopic and robotic surgeries.

Yes, the patient has to go for a surgery, if hernias spreads to quite an extent. In such cases, there are several steps that need to be taken as a part of the post-operative care for this surgery. Hernia surgery is quite common in today’s medical world. All you need to have is a good medical practitioner who would operate on you and you need to have complete trust on the expert and their methods of treatment. There are several ways to take care of yourself after the surgery. Some of these are explained below:

1. Diet includes liquids at first: During the first few days after the surgery, the patient is offered only liquids. Due to the anaesthesia, it becomes difficult to consume solid food initially. Only when the doctor sees that the patient is fit enough to consume solids, will solid foods be given to the patient. This is also an indicator that the patient is recovering well and might be let off soon from the hospital.
2. Patient is discharged only after anaesthetic effects are completely gone: For some time after the surgery, the patient is under the effects of the anaesthesia. If it is a local one then it would take a few hours for its effects to completely subside. But if it is a complex one, then it might take some more time for its effects to completely withdraw. Only after the patient is completely out of the effects of anaesthesia, will he/she be allowed a discharge.
3. Avoid headache: Patients are made to lie down flat on their back for at least a few hours after the surgery so that they do not experience anaesthetic headache. This can be painful and unbearable at times. But this can be avoided if the patient lies down for quite some time till the effects of it have worn off.
4. Shower: Usually there is a restriction in getting the operated area wet. But a shower can be carefully taken after at least two days of the operation.

Thus, these are some of the most important post-operative hernia surgery care tips. If you adhere to these points, your recovery process will speed up and it would prevent you from getting affected by any other health problems in your recovery period.

At the time of a surgical procedure, while making an incision a doctor has to take care of a number of factors before making an incision. Considering a number of factors, different types of incisions have come into fore, such as 

1. Midline Incision: It’s the commonest incision and is done along the linea alba (fibrous structure running through the mid of the abdomen). These are preferred, especially in diagnostic laparotomy as it permits a wide access to the abdomen.
2. Pfannenstiel Incision: It is transverse in nature, extending from the umbilicus to the pubic-symphysis. It is generally employed for abdominal hysterectomy of benign nature and caesarean section.
3. Chevron Incision: It is an incision under the rib-cage and is done on the abdomen. It starts from beneath the ribs on the right abdomen and extends till the other mid axillary line. Thus, the entire abdominal width is incised for proper reach into the liver. The incision can be up to 2 feet.
4. Kustner Incision: It is transverse in nature and extends from the symphysis pubis till the iliac spine (anterior). This type of incision takes time to perform. A Pfannenstiel incision offers more exposure than a Kustner incision.
5. Lanz Incision: It is a variation of the more common mcburney-incision (also known as Gridiron’s incision). It is generally used for open appendectomies. There are quite a few variations for this type of an incision.
6. Gridiron’s incision: It is done for appendectomies. It is an oblique short incision which is done in the lower right quadrant in the abdomen.
7. Kocher’s Incision: It is oblique in nature, extending from the abdominal upper right quadrant and is generally used for performing an open cholecystectomy. Gallbladder, biliary tract and certain liver operations can be suited for a Kocher’s incision. This however is different from the same named incision used for the thyroid gland surgery.
8. Cherney Incision: It is transverse in nature. It allows a great range of exposure for the pelvic sidewall. It is less painful than a midline incision. It allows for the greatest pelvic exposure and hence is a widely preferred and practiced incision. If you wish to discuss about any specific problem, you can consult a General Surgeon.