HELP!!! Esophagus procedure Thorascopic- 2nd request. need input or opinions Please...

LOKA715

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Uggh, ive looked at eveything... 43499?? or?

The injury to the esophagus itself was explored through a posterior mediastinal exploration. We were able to identify that there was a complete transection of the esophagus just below where the thoracic inlet enters the chest cavity. There was a fair amount of tissue damage that required some bit of debridement; however the edges of the mucosa appeared healthy and we were able to fashion in an end-to-end anastomosis. This was tested via EGD, which was performed by Dr. DeGraft- Johnson and this was shown to be airtight on insufflation with EGD, as well as with methylene blue insertion under pressure through NG tube. A fiberoptic bronchoscopy was performed as well and interestingly, there was a fair amount of blood in the right-sided bronchial system. Clearly we pulled back the endotracheal tube and fully visualized the trachea below the cricoid ring and there were no overt injuries seen and back in the chest we were able to see that there was an injury to the upper lobe and a laceration that clearly was the source of bleeding into the bronchial system. This was repaired using a wedge resection of that lacerated lung tissue. After completion of the anastomosis, we did close the mediastinal pleura back over the top leaving a drain next to the esophagus and irrigated with 6 liters of saline, the final 3 liters also included antibiotic solution. Lung reinflated well at the end of the procedure.
 
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