Today was Pre-Op. Jim and I and Jim's sister, Dianne, spent much of the day at University of Iowa Hospitals and Clinics in Iowa City. The day consisted of meeting with the surgeon, a resident and a nurse and members of the anesthesia team, along with lab work, an EKG, chest x-ray and neck x-ray, and lots of waiting inbetween times.
When is the surgery date:
Surgery is May 5 -- 14 days from now. Check in time is 6 a.m., surgery begins at 8:15 a.m.
Who is the surgeon:
Dr. Kalpaj Parekh
How long will surgery last:
It should take between 3 and 4 hours.
Where is the cancer located:
Cancer is in the lower esophagus only.
What technique will be done:
Trans-hiatal esophagectomy.
The surgeon will make two large incisions, one in the neck area and the other in the abdomen, from about the belly button to the bottom of the sternum bone. All of the esophagus (11 centimeters or about 6 inches) and the top third of his stomach will be removed. The stomach will be pulled up behind the heart and re-attached to a tiny bit of the esophagus (about 2-3 centimeters) and then attached to his throat area. The stomach will become his new esophagus.
There will be sutures in the neck area for 2 weeks and staples in the abdomen.
Eating:
A feeding tube will be placed in his small intestine, to provide more nutrition. Until his first post-op visit (4 weeks), eating will consist of clear liquids to full liquids to a soft mushy diet. Any eating at any time should be in small amounts, slowly. It all depends on how well Jim tolerates swallowing and whether he has problems with nausea, cramping, etc. The feeding tube may be removed after that first visit or it may remain in for up to 3 months.
What are the risks:
The highest risk is leakage in the neck area where there are sutures. There is, however, less than a 10 percent chance this will happen. Also bleeding because of the type of procedure and damaging organs.
What is preparation the day before surgery:
Bowel prep, like you do for a colonoscopy, beginning no later than 1 p.m. on May 4.
Can have a big breakfast or brunch, but once the bowel prep is started, can only have clear liquids up to midnight.
When will he be released from the hospital:
If all goes well, he will be released to go home on day 5.
Miscellaneous:
He may have chest pain, a sore throat and hoarseness after surgery. An epidural in his back (like women in labor) is recommended for pain. A home health aide or visiting nurse is likely to be part of the home recovery package. He is to get up and take walks regularly. Walking starts the day after surgery. He will have deep-breathing and coughing exercises.
We appreciate the prayers of all of you and continue to covet them as we go forward. It is not an easy road to be on, but we are thankful for our Lord and Savior and for all of you.
