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Learn About Conditions and Procedures

What is Trauma?

Trauma is a serious injury or shock to the body. It is caused by a physical force such as violence or an accident. The injury may be complicated by psychiatric, behavioral, and social factors.

It is critical to have an entire team immediately available to provide care to an injured patient 24-hours a day. This teamwork starts at the scene of the injury where a coordinated, statewide pre-hospital medical system rapidly transports the injured patient from the scene to the hospital providing the appropriate level of care according to criteria established in the statewide trauma regulations. Once at the hospital, a complete team of surgeons, emergency physicians and nurses continue the life-saving treatment.

This team approach to care of the injured patient has had a dramatic impact on saving lives.

Minimally Invasive Procedures for Massive Bleeding

Injuries take many forms. The most advanced hospitals can treat injuries with a variety of approaches that involve well-known ones, like surgery, and newer ones where minimally invasive procedures can replace some surgeries.

As a Level 1 Trauma Center, Hartford Hospital has Interventional Radiologists as part of the Trauma Team. They perform procedures such as "embolization" which is a recognized interventional radiology technique that is used to treat trauma patients with massive bleeding.

Click here to see some of the advanced interventional techniques available at Hartford Hospital.

Learn more about trauma, or search below to learn about other health conditions.

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Esophagectomy

(Removal of the Esophagus)

by Krisha McCoy, MS

En Español (Spanish Version)

Definition | Reasons for Procedure | Possible Complications | What to Expect | Call Your Doctor

Definition

This is surgery to remove the esophagus. The esophagus is the tube that runs from the mouth to the stomach.

Reasons for Procedure

Esophagectomy may be used to treat:

Esophageal cancer
Benign tumors and cysts of the esophagus
Other esophageal abnormalities

Esophageal Cancer

Possible Complications

If you are planning to have esophagectomy, your doctor will review a list of possible complications, which may include:

Bleeding
Blood clots
Infection
Soreness in throat
Adverse reaction to the anesthesia
Leaks from the internal suture line
Heart attack

Factors that may increase the risk of complications include:

Pre-existing heart or lung conditions
Advanced age
Obesity
Smoking
Diabetes
Excessive alcohol intake

Be sure to discuss these risks with your doctor before the procedure.

What to Expect

Your doctor may do the following:

Physical exam
Blood and urine tests
Chest x-ray —a test that uses radiation to take pictures of structures inside the body
Ultrasound—a test that uses sound waves to examine structures in the body
CT scan —a type of x-ray that uses a computer to take pictures of structures in the body
MRI scan —a test that uses magnetic waves to make pictures of structures in the body
Upper endoscopy —a thin, lighted tube inserted down the throat to examine the esophagus
Place a feeding tube into your small intestine (may be done during the esophagectomy)

Leading up to your procedure:

Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
- Anti-inflammatory drugs (eg, aspirin )
- Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)
Arrange for someone to drive you home from the hospital and to help you at home.
Eat a light meal the night before. Do not eat or drink anything after midnight.
Your doctor may ask you to:
- Use an enema to clear your intestines
- Follow a special diet.
- Take antibiotics or other medicines.
- Shower using antibacterial soap the night before the surgery.

General anesthesia will be used. It will block any pain and keep you asleep through the surgery. A tube will be placed in your windpipe to help you breathe.

Depending on the area that needs to be removed, the doctor will make an incision in the neck or abdomen using one of these techniques:

One large incision (open procedure)—The doctor will locate the diseased area and remove it.
Several small incisions ( robot-assisted procedure)—A tiny camera and small surgical instruments will be inserted through the incisions. Looking at the esophagus on a monitor, the doctor will locate and remove the diseased area.

A "replacement" esophagus will be formed with part of the stomach. The remainder of the esophagus will be attached to this new esophagus. In some cases, lymph nodes in the area will also be removed. One or more chest tubes will be placed to drain fluids. Lastly, the incisions will be closed with stitches or staples.

About six hours

You will feel pain as the anesthesia wears off. Ask your doctor about medicine to help with the pain.

This procedure is done in a hospital setting. The usual length of stay is 1-2 weeks. Your doctor may choose to keep you longer if complications arise.

You will not be able to eat or drink anything during the first week after surgery. You will get nutrition through a feeding tube. Within 7-14 days, you will have a swallowing test to check for leaks. If there are no leaks, your diet will gradually progress from clear liquids to soft, solid meals. You will probably be able to return to a normal diet after about a month. Your stomach will be smaller, so you will need to eat smaller portions.

You will also need to do deep breathing exercises. You may be given an incentive spirometer. This is a device to help you breath deeply.

Your doctor will encourage you to walk every day.
Avoid heavy lifting for 6-8 weeks.
Ask your doctor about when it is safe to shower, bathe, or soak in water.

Call Your Doctor

After you leave the hospital, call your doctor if any of the following occurs:

Signs of infection, including fever and chills
Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
Nausea and/or vomiting that you cannot control with the medicines you were given after surgery, or which persist for more than two days after discharge from the hospital
Pain that you cannot control with the medicines you have been given
Pain, burning, urgency or frequency of urination, or persistent bleeding in the urine
Cough, shortness of breath, or chest pain
Constipation or diarrhea
Pain and/or swelling in your feet, calves, or legs

If you think you have an emergency, call for medical help right away.

American Cancer Society

http://www.cancer.org/

National Cancer Institute

http://www.cancer.gov/

Canadian Cancer Society

http://www.cancer.ca/

National Cancer Institute of Canada

http://www.ncic.cancer.ca/

Esophageal cancer—esophagectomy. University of Maryland Medical Center website. Available at: http://www.umm.edu/thoracic/esoph_surgery.html. Accessed March 1, 2007.

Ivor Lewis esophagectomy. Roswell Park Cancer Institute website. Available at: http://www.roswellpark.org/Patient_Care/Types_of_Cancer/Esophageal/Esophageal_Center_Patient_Handbook/Ivor_Lewis_Esophagectomy. Accessed March 1, 2007.

Robot-assisted thoracic procedures PIB. Health Library website. Available at: http://healthlibrary.epnet.com/GetContent.aspx?account=hotk2. Accessed March 1, 2007.

Last reviewed November 2012 by Daus Mahnke, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.