Minimally invasive surgery for esophageal leiomyoma

Esophageal leiomyoma is a very common disease in daily life, and its incidence has been increasing in recent years. Although this is a benign disease, it can worsen if not properly cared for or treated, so people need to pay attention. With the development of medical technology, patients can be treated through minimally invasive surgery for esophageal leiomyoma. Friends in need can learn more about the relevant knowledge.

1. Minimally invasive surgical treatment of esophageal leiomyoma

Although leiomyoma is a benign disease, it has the potential to become malignant. Generally, the growth is slow, but the lesions continue to progress. When they are larger, they can compress the surrounding tissues and produce a series of complications. Therefore, except for patients who are older, have smaller tumors, have no obvious symptoms, have poor cardiopulmonary function and cannot tolerate surgery, or patients who refuse surgery, they can be followed up and observed. Otherwise, once the diagnosis is clear, surgical treatment is recommended.

2. Choice of incision

The surgical approach is determined by the location of the tumor, so a detailed X-ray positioning examination should be performed before surgery. The pedicle of polypoid leiomyoma is mostly in the esophagus of the neck, and an oblique incision is made through the pharynx or neck; if it is located in the upper esophagus, a right anterolateral or posterolateral incision is made; if it is located in the middle or lower segment, a left or right posterolateral thoracotomy incision is made.

3. Surgical Method

Most mucosal tumors can be removed surgically. Before the operation, a gastric tube without side holes is placed (the section with side holes at the distal end of the gastric tube is cut off). After thoracotomy, based on the location known from preoperative X-ray examination, the esophagus is freed near the tumor. After the tumor is felt, the section of esophagus is gently pulled out from the mediastinum with a belt. At the most raised part of the tumor, where the muscle layer is thinnest, the muscle layer is bluntly separated longitudinally along the direction of the muscle fibers to expose the tumor. After finding the interface, separate carefully along the tumor outer membrane to avoid damaging the mucosa. After the tumor is removed, if mucosal damage is suspected, pull the end of the gastric tube to the surgical site, temporarily block the upper and lower ends of the esophagus with tape, inject warm saline into the chest, and then inject air through the gastric tube to check for leaks. If there is any damage, repair it with a fine needle and thread and tie a knot inside the cavity. The muscle layer is separated and sutured loosely. If the muscle layer is very thin, it can be reinforced by suture with nearby mediastinal pleura, pericardium or diaphragm. If necessary, free intercostal muscles can be used for coverage.

If the defect is larger, it can also be repaired with polyester sheets to prevent the formation of diverticula after surgery. Larger tumors may free a longer section of the esophagus, and esophageal necrosis generally does not occur. Some tumors that are free for more than 10 cm can still recover well.

4. A small number of patients require partial esophagogastrectomy. The indications are:

① The tumor is large and irregular in shape, and is severely adhered to the esophageal mucosa and difficult to separate.

②Multiple leiomyomata are not easy to be removed one by one.

③ Although there is a malignant disease, the possibility of malignancy cannot be ruled out by frozen sections during surgery.

④Myoma combined with esophageal cancer or giant diverticulum.

⑤ During the operation, the tumor is severely adhered to the mucosa, and the mucosa is severely damaged and difficult to repair.