Dr. Orringer

Most people equate the joy of eating to the joy of tasting. But imagine how life would be if you couldn’t swallow foods and had to rely on a feeding tube for nourishment. That’s what many of Dr. Mark Orringer’s patients face daily — and some of them lived this way for years before they met him.

“Your esophagus is an 11-inch-long tube of muscle that propels swallowed food into your stomach,” explains Dr. Orringer, professor and head of the University of Michigan Section of Thoracic Surgery. “If you can’t swallow, you are severely disabled and are unable to enjoy one of the greatest pleasures of life – eating.”

In the past, operations to remove a diseased esophagus and replace it were more highly invasive than they are today. For example, if a patient had cancer of the esophagus, the standard procedure was to open the chest and remove the cancerous portion of the esophagus. Then, in order to create a new swallowing passage, the abdomen was opened, and the stomach was freed from its attachments and pulled into the chest through an opening in the diaphragm called the hiatus. From there, the stomach was sewn to the remaining portion of the original esophagus in the chest.

This method had many complications. Combined incisions in the chest and abdomen were very painful and made it extremely hard to breathe after surgery, which increased the risk of pneumonia. If a leak developed where the esophagus had been attached to the stomach in the chest, there was a 50 percent chance of developing a lethal infection. The procedure was tough (and not often an option) for the weak and elderly. Weeks in the hospital and a long convalescence were common.

Refining a Different Approach

Then, in 1977, Dr. Orringer reintroduced and refined a little-known technique called a transhiatal esophagectomy (THE).

This approach also requires an abdominal incision, but instead of opening up the chest, a second incision is made on the left side of the neck. Working upward along the esophagus through the abdominal incision and downward along the esophagus from the neck incision, the esophagus is progressively loosened from its attachments.

The diseased esophagus is then pulled out of the chest and removed, leaving only two inches of the esophagus remaining in the neck. The stomach, which according to Dr. Orringer, is like a large bag, is then stretched up through the diaphragm and the chest until it reaches the neck where it is connected to the remaining esophagus. Avoiding a chest incision reduces the risk of lung complications; if a leak between the esophagus and the stomach should occur in the neck, it is far more easily treated compared to the older operation where this problem occurs down in the chest. The mortality rate for THE at UMHS has been reduced to a remarkable two percent.

Recovery for this method also is much easier. Patients typically do not go into the intensive care unit after a THE and are up and walking the next day. They are able to begin a liquid diet in three to four days, and eat soft foods by the end of a week, which is when they are ordinarily discharged.

Dr. Orringer and his team have performed more than 2,000 THE procedures in the last 25 years, and he continues to teach this technique around the world today.