Sergei Dolgopolov MD General Surgeon NYC
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Surgical Experts Dedicated to Improving Lives

2019-best-gastrointestinal-surgeons-award-new-york-NY-awards
We recently received an award for Best Gastrointestinal Surgeons in NY for 2019. Click for the Press Release.

At Lenox Hill Surgeons, our dedicated team of nyc surgeons and medical professionals provide compassionate care with the highest ethical & professional standards. In our state of the art facility, we offer surgical services using only the most cutting edge and current procedures and treatments.We specialize in general surgery, including extensive experience in performing hernia repair surgery. Our expertise is in minimally invasive surgery and robotic surgery. Minimally invasive and robotic surgery often allow patients to experience easier recovery than traditional open surgery. They also allow for more precise and less traumatic surgery. When robotic and minimally invasive surgery is not an option, we are also skilled and experienced in traditional open surgical procedures.

All of our doctors are experienced and skilled surgeons having undergone extensive training in school, residency and fellowships. They all practice medicine with ethical behavior, compassion and superb bedside manner. In the operating room they all exhibit precise mechanical abilities, analytical thinking and the ability to visualize tissue in three dimensions. These innate and learned skills allow our surgeons to be some of the most dexterous and skilled professionals in all of New York City and the Country.

Category Archives: Esophagus Surgery

Esophagus Surgery – What to Expect

esophagus-surgery-info-surgeons-new-york-01The esophagus is an essential aspect of digestion. Without it, you couldn’t naturally deliver food from your mouth to your stomach. However, there are some times where surgery needs to be performed on the esophagus. How does the esophagus work? What can go wrong and how can surgery help? What is recovery like for esophagus surgery?

How the Esophagus Works

The process of digestion begins as soon as food enters the mouth. The very first step in digestion is chewing, breaking down large chunks of food into smaller, more manageable pieces. Saliva is also brought into the mix to help chemically reduce the food as well. In order for the food to continue to be processed by the stomach, intestines, and other associated organs, it needs to travel down the esophagus. When we first think of it, we might imagine that the esophagus is simply a tube, similar to a straw. We may think that food simply falls down our throat and into our stomach, that the esophagus is a very simple structure. That could not be further from the truth! In fact, there are many muscles that are involved in delivering food from the mouth to the stomach. This can be seen by the fact that we can swallow sitting down, laying down, or even upside down.

Once food enters the esophagus, the smooth muscle tissue within the esophagus contract in a wave formation, gradually pushing food down our throat. Additionally, there are two valve-like structures, called sphincters, that block entrance two or exit from the esophagus. Without these sphincters, food in our mouth would instantly drop down to the stomach. Alternatively, digestive enzymes and juices could come up from the stomach, known as acid reflux.

What can go Wrong

top-nyc-surgeons-for-esophagus-02Clearly, the esophagus is more than just a hollow tube for swallowing. Because of the complex nature of the esophagus, there are a number of things that can potentially go wrong. As mentioned above, the sphincters within the esophagus are essential for proper digestion and processing of food. In severe cases of acid reflux, surgery must be performed to tighten the sphincter that separates the esophagus from the stomach. Alternatively, these sphincters can become overly tight or lacks the mobility to properly deliver food to the stomach. In these cases, surgery is required to open up the affected area and facilitate swallowing. Another common situation necessitates surgery of esophagus is cancer.

As with any cancer, esophageal cancer poses of risk for metastasis, or spreading of cancer throughout the different systems of the body. If cancer has been found in the esophagus and is localized, your surgeon may recommend that some or all of the affected tissue is removed.

Esophageal Surgery Recovery

how-does-esophagus-surgery-work-03Of course, the exact length of recovery for esophageal surgery will vary depending on the amount of surgery required. Depending on the specific protocols followed, some esophageal surgeries will only require a few days of recovery before returning home. Other, more involved surgeries may require an extended stay with close observation. Some changes may need to be made in your lifestyle, such as changes in diet and temporary limiting of strenuous activity.

As a general principle, any activity that causes pain in the affected area should be avoided for the first few weeks. Your surgeon will have more specific instructions for you as far as what to expect with your precise procedure, what to do to prepare, and what lifestyle changes may need to be made.

Are you in need of esophageal surgery? Get in touch with the best surgeons in NYC to schedule an appointment today.

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References:

https://surgery.ucsf.edu/conditions–procedures/esophageal-cancer.aspx

https://www.cancer.org/cancer/esophagus-cancer/treating/surgery.html

https://www.ariahealth.org/programs-and-services/surgery/general-surgery/surgery-for-esophagus

 

Dysphagia Surgery: Steps, Benefits, Side-Effects, Precautions & Prognosis 

Dysphagia Surgery

dysphagia-surgery-problems-swallowing-nyc-surgeon-specialists-01Some functional and anatomical abnormalities of the esophagus or the pharynx can cause dysphagia which is essentially a fancy medical term to indicate difficulty swallowing. This condition can be successfully treated by surgical procedures. Also, surgery is recommended when dysphagia is found to be associated with esophageal carcinoma, and compression of this organ due to other abnormalities or tumors in the chest. The surgical methods presently available are varied, and the choice of medical procedure is decided by the causative condition of dysphagia.

Steps

  • The LES or lower esophageal sphincter is dilated in patients with achalasia. The doctor makes the patient swallow a tube having a balloon at its end. It is placed across the LES by means of an X-ray, and then the specialist blows the balloon all on a sudden. The objective is to stretch, rather tear, the sphincter. It can also be useful in treating Schatzki rings and strictures and other anatomical problems associated with
  • In esophagomyotomy, the surgeon cuts the LES by making a large incision in the abdomen, or laparoscopically where small punctures are made in the chest or the abdomen of the patient.

Benefits

esophageal-dysphagia-general-information-top-nyc-experts-02For patients with severe dysphagia disorders, it may be necessary to bypass the pharynx entirely and the oral cavity to provide them with enteral nutrition. Surgical alternatives range from IOC or intermittent oroesophageal catheterization to PEG or percutaneous endoscopic gastronomy. Surgery for chronic cases of aspiration may include the following procedures:

  • Medialization: It restores subglottic pressure and glottis closure during the swallow.
  • Laryngeal suspension: The larynx is made to be rest in a comparatively protected place under the tongue.
  • Laryngeal closure: The medical practitioner may perform it to shut the glottis off, and thus, provide ample protection for the airway while sacrificing the quality of phonation.
  • Laryngotracheal separation-diversion: It may be opted to separate the alimentary tract from the airway.

Complications

The most commonly occurring complications are bleeding and perforation of cricopharyngeus. Dysphagia is typically reported after undergoing an ACS surgery, i.e., surgery of the anterior cervical spine. Although risk factors associated with dysphagia are published in the journals, they remain controversial to date.

Precautions 

  • The healthcare professional may prescribe making an alteration in food/liquid texture, temperature, or consistency.
  • It is vital to ingest slowly and take smaller bites.
  • The caregiver should also strictly adhere to the promoting strategies to ensure increased safety.
  • It is crucial for one to maintain an appropriate positioning at the time of eating, and the ideal manner is to consume any liquid or food while holding an upright position, and also the chink being tucked a little at a right angle.
  • An individual should continue to maintain the upright position even after finishing one’s meal, and should not make any attempt to alter the present position for a minimum of forty-five minutes post-consumption of the meals.
  • If a person is found to be diagnosed with GERD also, then the head of the patient’s bed should be inclined at an angle of forty-five degrees.
  • The care provider should always remember not to give an aspiration patient anything to consume a few hours before the bedtime.
  • One should use medications that are meant to promote stomach emptying and reduce the reflux.

Prognosis

It is rather impossible for anyone to predict the outlook or prognosis for dysphagia in general, as numerous medical conditions can be held responsible for the symptoms associated with it. The outlook is case-dependent and is decided by the underlying medical issue/s of a patient.

Conclusion

Although dysphagia can appear to be frightening, this condition is not always necessarily chronic. The family physician should be consulted as soon as one starts experiencing any swallowing difficulties or other GERD (Gastroesophageal reflux disease) symptoms. The latter can be effectively treated with prescription drugs to reduce the amount of stomach acid.

Get in touch with us at 212-988-1136 or schedule an appointment to get immediate care and treatment for the condition.

References

  1. https://www.emedicinehealth.com/dysphagia_swallowing_problems/article_em.htm#dysphagia_swallow_disorder_facts
  2. https://www.healthline.com/health/gerd/dysphagia
  3. https://emedicine.medscape.com/article/2212409-treatment#d20
  4. http://www.newhealthadvisor.com/Aspiration-Precautions.html

Surgery for Esophageal Cancer – General Surgeon NYC

Esophagus Surgery: Steps, Benefits, Side-Effects, Precautions & Prognosis

expert-top-esophagectomy-cancer-surgeon-nyc-01

Esophagogastrectomy or esophagus surgery entails doing away with the entire esophagus (and often a stomach part) for treating esophageal cancer, Barrett’s esophagus, achalasia, esophageal stenosis, and GERD. The thoracic surgeon transforms the remaining section of the stomach into a tubular form serving as the replacement for the excised esophagus. The reconstructed esophagus enables the patient to swallow as he or she was doing before the surgery.

Steps

A surgical team comprising of medical specialists and headed by a thoracic or general surgeon performs esophagogastrectomy. The surgical procedure is usually open-type and is carried out in three separate ways.

  1. Transthoracic esophagectomy (TTE) is conducted via the chest cavity
  2. Transmittal esophagectomy (THE) is performed by making incisions in the breastbone and the neck’s left side
  3. En bloc esophagectomy is performed by perforating the abdomen, chest, and neck

Nowadays, the majority of the esophageal surgeries are done using the minimally-invasive laparoscopic procedure where 5-6 fine incisions are made in the abdomen, chest, and neck. The total number of slits (along with their locations) to be made are decided based on the purpose of carrying out the operation and whether the patient has undergone abdominal or thoracic surgeries on previous occasions.

Regardless of the type or method used, the operation is complex thereby necessitating an extended stay in the hospital. If the metastasis is limited to the esophagus and not spread further, excising the gullet and adjacent lymph nodes might help reverse cancer. Alas, most of the cases are detected at an advanced stage compelling the surgeon to go for a compound surgery.

 Benefits

esophageal-cancer-surgeons-minimally-invasive-esophagectomy-nyc-02

Minimally invasive esophagectomy has proven to be more effective compared to open esophagectomy as the postoperative mortality and morbidity rates related to the former are much lower. There are numerous studies to corroborate the outcomes associated with MIE are better than PE. Some of the likely benefits associated with MIE vis-à-vis PE comprise:

  • Ashorter period of hospitalization
  • Less painful procedure
  • Reduced risk of complications or infections
  • Less bleeding (and hence fewer transfusions)
  • Speedier return to leading a normal life

Side Effects

Some complications related to esophageal surgery are common to other forms of surgery including but not limited to:

  • Stroke and heart attack (while the operation is in progress)
  • Shortness of breath
  • Anastomotic leaking (low blood pressure, vomiting, surgical wound drainage, increased heart rate, and so on)
  • Bleeding
  • Pulmonary embolism

Complications or risks particularly associated with esophagogastrectomy (which are somewhat rare) include:

  • Acute chest infection
  • Pulmonary complications, particularly pneumonia
  • An injury or wound to the adjacent organs during the operation
  • Leakage at the junction of the conjoined stomach and esophagus

Precautions

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The surgeon who will operate will spell out the risks about the surgery as well as the preparations and precautions you to need to take before, after and during the procedure. You’ll have to quit smoking altogether at least before the surgery and possibly afterward as well. You’ll have to abide by the instructions specified by your surgeon once you’re discharged from the hospital.

The precautions that you’ll need to take will revolve around your diets, medications, clothing, personal accessories, and lifestyle.

Prognosis

The quality of life of most patients improves post-surgery, but some complications linger on. Follow-up care in the form of pain management, lung therapy, psychosocial care, and nutritional evaluations are highly recommended by the medic to keep the complications or risks at bay.

Concluding Remarks

Minimally invasive esophagectomy or esophagogastrectomy is evidentially the best form of surgical treatment for patients with esophageal cancer. If you or somebody close to you has been diagnosed with neoplasm of the esophagus, you can contact us to make an appointment with our general surgeon for a consultation.

References

  1. https://www.uwhealth.org/healthfacts/surgery/4281.pdf
  2. https://www.cancer.org/cancer/esophagus-cancer/treating/surgery.html
  3. https://www.ariahealth.org/programs-and-services/surgery/general-surgery/surgery-for-esophagus
  4. https://www.cancercenter.com/esophageal-cancer/surgery/
  5. https://www.healthline.com/health/esophagectomy-open#postsurgery
  6. https://www.cancercenter.com/esophageal-cancer/da-vinci-surgical-system/
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4283863/
  8. https://www.mayoclinic.org/tests-procedures/esophagectomy/about/pac-20385084
  9. https://www.uwhealth.org/healthfacts/surgery/4281.pdf
  10. https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=134&contentid=154