Replacing a Burnt Gullet
“A difficult but rewarding task”
Continuing my previous story, this is a summary of my experience in treating patients suffering from burnt gullets / stomach which includes in brief the surgical procedures used to relieve their suffering by replacing the burnt gullet with another segment of the digestive tract illustrated with photographs and X rays.
Unable to take in the required nourishment for survival these patients were in a poor state of health at the time of admission to the ward suffering for varying periods of time. Some had undergone treatment in other hospitals without much relief while others were admitted with complications. Careful and meticulous attention to detail to optimise their health prior to surgery was an essential requirement. These included the following:
- Correction of any underlying nutritional deficiencies
- Treating any complications related to previous procedures
- Assessing the suitability for a major surgical procedure
- If the oral route could not be used to feed adequate quantities we introduced a tube to the stomach / small bowel to feed them prior to surgery. This enabled special high energy liquid feeding
The non surgical method of treatment that had been used in these patients is called dilatation of the stricture (narrowing). This procedure had been used in many patients, sometimes on multiple occasions without much improvement. The old and the new techniques are described below in brief.
The old technique of dilating a stricture using a rigid oesophagoscope
“JUST IMAGINE A RIGID BRASS TUBE BEING PUSHED DOWN YOUR THROAT”
The new technique – Flexible gastro-oesphageal video endoscopy
The success of this procedure depended on many factors
The most important were;
- The type of stricture and the site
- The number of strictures
- The involvement of stomach
The type of strictures in gullet and stomach
The majority of the patients who were admitted to my ward at SJGH had undergone many procedures such as repeated dilatations which have not been successful in providing a lasting benefit. In such cases the only option was either to remove the ‘burnt gullet’ and replace it or by-pass the damaged gullet with another segment of the digestive tract either the colon or the stomach. Removing and replacing the damaged gullet was the better option.
Many techniques have been used by surgeons. The technique that I used is described briefly without going into much detail.
REMOVAL OF THE DISEASED GULLET (OESOPHAGUS)
THE NEXT STAGE OF THE OPERATION IS THE REPLACEMENT OF THE GULLET THAT IS REMOVED WITH EITHER THE
- LARGE BOWEL (COLON) OR THE
Those who are interested in reading more on this subject are advised to refer to my PUBLICATION in this website titled
SURGICAL MANAGEMENT OF BENIGN STRICTURES OF THE OESOPHAGUS: 18 YEARS OF EXPERIENCE (click here to view the post)
I would also like to draw your attention to two more stories related to this subject
From darkness to light (Click here to view the post)
Silva back at his “wheel” (Click here to view the post)
12 thoughts on “Replacing a Burnt Gullet”
Excellent surgical expertise and description. Congratulations to Dr Gamini and his team.
What a feeling it may be to enjoy a meal. What thoughts would now go through the minds of the patients who have recovered……
No amount of thanking is enough to the Surgeon.
To this unasuming skilled Surgeon, its another challange & a yuthukama-perata.
A God given gift very well utilised. Therefore, every surgery done turns precious.
CHOICEST BLESSINGS !!!!!!!!!!!
Truly a difficult and rewarding task from an exemplary surgeon
A great service
The contents that you have discussed are extremely interesting and satisfying for both the patient and the surgeon. You have acted as a saviour to the distressed person who has benefited from your expertise as a surgeon. A job well done!
Dear Sir, we were eye witnesses of those ‘miracle’ surgeries when we were doing our surgical appointment at the Sri Jayawardenapura General Hospital. We were lucky to have you as a great teacher
Sir, I had the opportunity to see those difficult procedures while I was a student in your ward
Sir, the photo shows our clinical group. We are so proud to be your students during our days at the medical faculty.
Such an interesting read. being a non medical, reading through certainly is scary and is also chilling to read that a surgeon can so cleverly give back the life to such patients is unimaginable until you read and understand the true dedication of a true surgeon. Gamini, I see the halo shining above your head. Marvellous!
Wow what good work you have done. I do a considerable amount of robotic two field and three field oesophagectomies ( Ivor Lewis and Mckeowen) mainly for cancer but never for a caustic stricture. It seemed you did the Orringer technique and dissected blindly in the mediastinum. Operating in this area under 10x magnification now with the dexterity of the robot seems like child’s play, This is the comparison to you the master surgeon who knew how to strip the oesophagus off the aorta skillfully and blindly. Amazing. It seems the results are wonderful. Kudos on saving those lives.
Your commitment to these heart wrenching situations is sure to be recorded and recognised in history
Yes, Doctor, your presentation and description could be understood by a non medical person too. Great, what you have done.