What is the function of the esophagus?
Move large food boluses, water and saliva from pharynx to stomach.
How much can the esophagus expand during swallowing?
double or tripple
T/F the esophagus is constantly movign
True - from swalling and respiration
What are the 4 layers of the esophagus
Which tissue layer does the esophagus not have?
How would you describe the blood supply to the esophagus?
segmental - 3 portions
What are the 3 portions of blood supply?
The thyroid arteries well-vascularize which part of the esophagus?
The bronchoesophageal artery less well supplies which part of the esophagus?
The branches of gastric arteries supply which part of the esophagus?
Is the esophagus easy to deal with surgically?
No - try to refer it
What makes the esophagus difficult? What are potential repercussions of surgery?
When should surgery be performed on the esophagus?
Only if there is no better alternative
What is vital to maintain during surgery to the esophagus?
What should be minimized during surgery to the esophagus?
The esophagus is a high ____ area.
Follow principles of _____ when operating on the esophagus.
Incision into the esophageal lumen =
Will you ever remove the esophagus?
Not all of it, but partial esophagectomy and anastomosis possible
What is a suture that is placed through tissue, then used to retract tissue called?
What happens to the free ends of this suture?
Free ends clamped with a hemostat
Where is surgical access for the cervical esophagus?
Ventral cervical midline approach
Where is surgical access to the cranial thoracic esophagus?
Left 3rd intercostal thoracotomy
Where is surgical access for the mid thoracic esophagus?
Right 5th intercostal thoracotomy
Where is surgical access for the caudal thoracic esophagus?
Left sided 8th intercostal thoracotomy
Before esophageal surgery is performed what 2 things help maintain asepsis?
Esophagus is suctioned transorally
Surgical site is isolated/packed off
After closure of esophgeal surgery, what occurs before lavage?
Change sterile gloves & instruments
Surgical contents are contaminants.
For an esophagotomy, what is used to incise?
11 blade to incise
metzenbaum scisors to extend
What two types of closures are possible with an esophageotomy?
Which is preferred?
double layer or single layer closure
Single just as good.
Where are the knots in a double layer closure?
Deep laer - knots burried in lumen
Superficial layer - knots on outside
What is the most important component of a single layer esophagotomy closure?
Get the submucosa in the suture or the incision will dehisss
What suture should be used for esophagotomy
Monofilament = pds
What suture pattern should be used ofr an esophagotomy and why?
Simple interrupted to obtain good apposition.
When resecting/anastomosing in a partial esophagectomy, which tissue should be resected?
What is key in closing a partial esophagectomy?
How many layers can be used to close a parital esophagectomy and what is the pattern/goal of sutures?
1 or 2 layer
How much of the esophagus cervical vs thoracic can be removed in an esophagectomy? What is the limiting factor ?
20% cervical vs 50% thoracic
-may need tension-relieving technique
What are the 6 more common esophageal diseases?
1. foreign body
4. vascular ring anomaly
5. hiatal hernia
6. cricopharyngeal achalasia
Which animals are more prone to esophageal foreign body?
What may be seen?
-Young indiscriminate eaters, small breed dogs more common to bones & sharp objects
Which animals are less prone to esophageal foreign bodies?
What may be seen?
cats - more discriminate
What are the 4 most common sites for FB to be lodged?
1. pharyngeal esophagus
2. thoracic inlet
3. base of heart
4. diaphragmatic hiatus
What are the c/s of esophageal fb?
Dysphagia, regurgitation, gagging, ptaylism, retching
What are regurgitating animals at risk for and what should be done?
Do thoracic radiographs - pharynx to stomach to not miss
What are 2 possible TX for esophageal foreign bodies and what % do they fix?
Endoscopy - 69% removed, 29% pushed to stomach
Only 8% require esophageal surgery
What is the first line of defence for esophageal foreign body?
Which surgery is preferable gastrotomy or esophagotomy?
When should surgery be done for esophageal fb (3)
If endoscopy unsuccessful
If FB pushed into tomach - gastrotomy
If perforation is present.
Should you do esophageal surgery in private practice?
If you're a surgeon.
It's good to refer it.
What post-fb-removal management should you consider? What is tx based on?
Tx aspiration pneumonia if present
Depends on severity of damage
Bands of intraluminal or intramural fibrous tissue in the esophagus which lead to an obstruction are called:
What do strictures occur secondary to (5)?
Gastroesophageal reflux under anesthesia
Is esophageal neoplasia common?
no, its rare
What are the types of esophageal neoplasia?
Primary: Sarcoma, SCC, Leiomyoma
Metastatic: Thyroid, pulmonary, gastric
What parasite may lead to esophageal neoplasia?
What congenital malformations (of great vessels) can lead to constriction of the esophagus?
How does it present?
Vascular ring anomalies (VRA)
-presents as regurgitation.
All vascular ring anomalies result from abnormal development of the ___ ____ # __ ___ & __. There are #___ different malformations reported.
aortic arch 3,4 & 6
7 dif types reported
90% of animals diagnosed with vascular ring anomalies have ____
PRAA persistent right aortic arch
45% of animals with PRAA have a __ __ ___ __. What is the surgical significance?
Persistent left vena cava
Runs over location of transection - may need to retract
10% of animals with PRAA have a __ __ ___
How is VRA diagnosed?
Survey thoracic rads
-look for apsiration pneumonia
Barium esophagram ideally with fluroscopy
On survey thoracic rads there will be a focal ____ curvature of the trachea nearthe cranial boarder of the heart in __ /___ views.
Both VRA and congenital VRA have what on rads?
How can they be differentiated?
Both = esophageal distension cranial to heart
Congential - huge all the way down
What must be considered when operating on PRAA?
TX secondary problems
If no aspiration pneumonia/severe malnutrition, do not need to delay sx
In SX for PRAA
Entry is by the ___ ___ ___ ___
Transect the ___ ___ & ___ ___ ___
Pass __ ___ or ___ ___
Entry: Left 4th intercostal thoracotomy 95%
Transect ligamentum arteriosum & periesophageal fibrous bands
Pass stomach tube or balloon catheter through constricted area
Elevated feedings of a slurry.
How often is PRAA surgery successful?
What is the most common complication?
Failure to resolve signs of megaesophagus
T/F Most VRA can be repaired via the same approach as PRAA.
T - left 4th intercostal thoracotomy
except persistent right LA w/left aortic arch
Protrusion of the abdominal esophagus or stomach through the esophageal hiatus is called what?
What causes hiatal hernia?
What are the signs?
Caused by congenital abnormality of the hiatus
--> Gastroesophageal reflux, esophagitis, regurtitation, vomiting
What passes with the esophagus through the hiatus?
The vagus nerve
What passes through the aortic hiatus?
aortia & azygus
What is the most common type of hiatal hernia?
Type 1: Sliding/axial, loose connection, herniates as part of stomach/esophagus
What are the other 2 types of hiatal hernia?
Type 2: paraesophageal - pouch off stomach
Type 3: sliding + paraesophageal - slide through & pouch
Cranial displacement of the stomach through the hiatus = hiatal hernia present with what c/s?
reflux and regurgitation
How do you dx hiatal hernia?
Rads of thorax, abdomen, pos contrast esophagram
If a hiatal hernia is sliding, what do you need to dx it?
Multiple radiographs or fluroscopy
What medical management is used for hiatal hernia?
Proton pump inhibitors
What surgical tx can be used for hiatal hernia?
Hiatal plication - close down hernia
Esophagopexy - tack esophagus
Gastropexy - tack stomach to body wall
What is the cause of hiatal hernia?
phrenico-esophageal ligament congenitally weakened or incomplete
hiatal hernia type ?
Gastresophageal sphincter is cranial to the esophageal hiatus?
1 = axial or sliding
Hiatal hernia type?
The gastroesphageal sphincter occupies a normal position while the fundus or other abdominal viscus herniates through the phrenico-esophageal ligament
2 - para-esophageal
Hiatal hernia type?
Both gastroesophageal sphincter and other abdominal viscus lie cranial to the hiatus
3 - combined
What happens in type 1 & 3 when the resting pressure falls?
The gastroesphageal sphincter moves into the thorax
results in gastro-esophageal reflux - hypersalivate, dysphagia, vomit, regurg, esophaguitis or gastroesophageal sphincter obstruction