In Pursuit of Health
All the information below can also be found in the VCH booklet: Before and After Esophagectomy Patient and Family Guide.
You are about to have an operation to remove your esophagus or "food pipe". This information has been put together to let you know what to expect before and after esophagectomy at VGH. This is meant as a guide only. Throughout your hospital stay, you will receive care from a team of health care professionals including:
Your thoracic surgeon
Thoracic clinical associates
Registered Nurses and Thoracic nurse practioners
Thoracic surgery fellows
All members of the health care team are available to answer your questions about your recovery.
What is an Esophagectomy, and Why is it done?
An esophagectomy is the surgical removal of the diseased part of the esophagus, or "food pipe". After the esophagus is removed, the stomach (or in certain situations part of the colon – large bowel) is attached to the remaining part of the esophagus (either in the chest or the neck). This reconnects your digestive system so that you will be able to eat again. There are many different kinds of esophagectomy, and every kind is possible to be done at VGH depending on your treatment need.
Laparoscopy is a type of "keyhole" surgery where the surgeon enters the abdominal cavity through five holes on your upper belly to pass a camera and instruments to prepare your stomach to connect to the upper part of your esophagus.
Video assisted thorascopic surgery (VATS) is a type of "keyhole" chest surgery where the surgeon enters the chest cavity through four holes between the ribs. Through these holes, the surgeon passes telescope type instruments. A camera is used to see and instruments are used to remove the diseased part of your esophagus.
A laparotomy is an incision (5cm to 8cm long) on your upper abdomen where the surgeon prepares your stomach to reconnect to the remaining esophagus in your neck.
A thoracotomy is an incision (5cm to 8cm long) between your ribs on the side that goes into the chest cavity.
Getting Ready for Esophagectomy at VGH
The Care You Deserve
Most patients come to the Pre-Admission Clinic (PAC) for their tests before surgery. The nurses in PAC will teach you about how to prepare for your surgery and answer any questions you may have. If you had a preadmission clinic visit, you will be admitted for surgery the day of your operation through the Same Day Admitting Unit.
The anesthetist is the doctor who puts you to sleep for your operation, and monitors your condition during the operation and in the recovery room. An anesthetist will see you in the PAC and ask you questions about your general health and any medications you are taking.
An anaesthetist will also talk to you about ways to relieve your pain after the operation. Your nurses and doctors will teach you how to describe your pain on a scale of 1 - 10, so it can be better controlled.
A technician from the lab will take a blood sample and do an ECG. You may also have a chest x-ray.
Your stomach should be empty for the operation. The evening before the operation, you may be given medication to clean out your bowels. After midnight, you are not allowed to eat anything. Only clear fluids (i.e. water, clear tea or broth) are allowed up to 3 hours before admission to hospital.
The Day of Esophagectomy - Before your Operation:
Helping You Get Healthy
Before your Operation:
Have a shower the night before and the morning of your surgery using the special wipes you have been told about at your preadmission visit. After your surgery it will be a few days before you can shower again.
Please leave all jewelry, credit cards and objects of value at home. The hospital in not responsible for any lost or stolen items.
Report to the Admitting Office promptly at the time you were told to do so.
You may be given some pills that have been ordered by the anesthetist and an intravenous (IV) may be started in your hand or arm.
About one hour before the operation, you will be taken to a holding area near the operating room.
Your family can stay with you until you go to the operating room.
Once you have gone to the operating room, your family should probably go home to await a call from your surgeon. Your family should leave the phone number where they can be reached, including a cell phone number if available.
If your family chooses to stay at the hospital, they can wait in the Critical Care Waiting Room on the 2nd floor of the Jim Pattison Pavilion beside the cafeteria.
The Day of Esophagectomy - After your Operation:
Taking Care of You
You will go to the Post Anaesthetic Care Unit (PACU) located on the 2nd floor of Jim Pattison Pavilion and stay in PACU overnight. You will be transferred to the 12th floor Chest Centre Special Care Unit (CSCU) later the next day. Only immediate family are allowed to visit in these areas, and only for short periods of time (about 10 minutes).
While most patients are drowsy after surgery, you will be aware of the nurses and doctors talking to you, and of the equipment used to check how your body is working.
You will be given oxygen by a face mask or by small nose prongs. Your nurse will check your oxygen level with a small finger probe called the “pulse oximeter”.
You will have an IV line in your neck vein. This line (called a central line) is used to give you fluid and medications. It was inserted after the anesthetist puts you to sleep.
You will have a small tube in your wrist. This tube (called an arterial catheter) is used to draw blood samples and to measure your blood pressure. It was inserted after you were put to sleep and will be removed the next day after surgery.
You will have a tube in your bladder called a foley catheter. This will be used to collect and measure your urine and will be removed by your nurse when it is appropriate to do so.
A Nasogastric Tube: also called an "NGT". It is inserted through your nose into your stomach. The tube is attached to a suction machine so that your stomach contents - brown or greenish in colour - can be drained and your stomach does not expand like a balloon. It also helps to prevent you from becoming nauseated. (Be sure to tell your nurse if you feel nauseated). This tube stays in for about 5 days, or until you are ready to eat.
"Chest tubes": You will have one or two drainage tubes in your chest that will be connected to collection containers and to suction. These tubes drain air and fluid that collect in your chest after surgery (the doctor will determine when your chest tubes are removed).
A "J-Tube": is a small, soft tube which enters your small bowel through the abdomen. You will be fed a liquid diet through this tube until you are able to eat. The tube feedings will be stopped once you are eating well.
You may have a very small tube in your back. This tube (called an epidural catheter) is used to give you pain medication. Another way of delivering pain medication is through your IV which you can control. This is referred to as Patient Controlled Analgesia or PCA. At least every hour the nurse will check your comfort level and your ability to move and feel your body.
Electrodes: You will have five small sticky pads on the front of your chest connected to a heart monitor. These will be on for 5 days.
Your nurse will check your blood pressure, heart rate and breathing rate at least every hour in PACU.
After your surgery, your nurse will encourage you to take deep breaths and cough, to gently exercise your arms and legs, and to turn in bed frequently.
Your nurse may help you to sit at the edge of your bed and provide you with some ice chips to moisten your mouth in the afternoon or evening the day of your surgery.
You will have one bloodwork drawn and have a chest x-ray early the next morning.