How can I live with only a portion of my esophagus?
Whatever is used to replace your esophagus (stomach or bowel) adjusts to become the tube that transports food from your mouth to your stomach or small intestines There are stitches (sutures) that hold these newly formed connections (anastomoses). Before you can use your "new food tube", the connections must heal.

What kind of tests do I have before I have surgery?
If your bowel is going to be used to replace your esophagus, you may need an angiogram to check that the blood supply to the bowel is good. This is important, since it will be removed and used as an esophagus replacement. You may also need a barium enema to check that the bowel is healthy

If the stomach is going to be used, you may need an esophagoscopy. This allows the doctor to look at the esophagus and the stomach through a scope to be sure the stomach is healthy.

It is possible you will need additional tests, depending on the reason you are having the surgery. Your doctor or nurse will explain the reason for the tests.

Is there anything I need to do before I am ready to have the surgery?
There are number of things that need to be considered before your surgery. Review this list with your "team" -your nurse, doctor, and family members to find out what items apply to you.

The health of your lungs is very important before your surgery.

• If you smoke, YOU MUST STOP SMOKING NOW! Please let your doctor or nurse know if you need help quitting.
• If your lungs are congested, you will need to use the incentive spirometer (device for deep breathing) as advised by your doctor.
• If your lung function needs to be improved, your doctor may recommend outpatient pulmonary rehabilitation.

Depending on the health of your heart and medical history, your doctor may recommend the following.

• An appointment with a cardiologist (heart doctor) for evaluation.
• EKG (electrocardiogram), thallium stress test, or cardiopulmonary stress test.

Prepare for healing after surgery by being as nutritionally sound as possible.

• The dietitian will assess your nutritional status. She may have you keep food diaries or recommend supplements. She will watch your weight and blood values before surgery. If you have lost a lot of weight because of the problem with your esophagus, you may require a feeding tube. A feeding tube is a soft tube that goes through your nose into your stomach. Liquid nutrition will be pumped into the tube. This will provide additional calories to help prevent weight loss and ensure adequate nutrition.

Have any infections in your mouth taken care of before your surgery. Let your doctor know about any gum infections or unfilled cavities.

What can I expect the day before my surgery?
There are a number of things that will be done once you are admitted to the hospital.

Empty all of the stool from your bowel before you go to surgery. Your bowel must be clean if it is going to replace your esophagus. Even if the plan is to use your stomach, your doctor will order the bowel prep. To empty the stool from your bowels:

• Eat and drink only clear liquids after breakfast. Clear liquids are fluids you can "see through" such as tea, Jell-O, and broth.
• Drink a bowel cleanser called Golytely. It is a gallon of liquid you drink so it has time to work before you go to sleep.
• Take enemas (a flushing of the large bowel with water) the night before surgery and the morning of your surgery to clean any stool that remains in your bowel.

Decrease the bacteria in your gastrointestinal tract (mouth, esophagus, stomach, and bowels)

• Take antibiotics by mouth the night before surgery.
• Swish an antibiotic and an antifungal liquid around in your mouth, gargle and then swallow at midnight.
• Receive another antibiotic through your IV at the time you are called to go to surgery. You will also be given the antibiotic and antifungal liquid to swish around in your mouth again and gargle.

Keep your stomach empty before surgery.

• Starting around 5 p.m. an IV (intravenous) catheter will be placed in your vein so that fluids can be given to you. This is a "saline lock" (IV that is capped off for use later).
• Beginning at midnight, you are to have NOTHING to eat or drink. This is called "NPO" or "nothing by mouth (per os)".

Meet with an anesthesiologist on the nursing unit. This doctor, who specializes in delivering anesthesia, will assess you and your medical history. He or she will explain the type of anesthesia that will be used for your operation.

What else will I have before I leave the nursing unit and go to the operating room?

Whenever you have surgery, you are at risk of getting blood clots in your legs. To prevent clots from forming.

• Support hose or anti-embolism (prevent blood clot) stockings will be put on your legs. These are snug hose that go up to your thigh. They are used to improve the flow of blood. It is very important to keep them pulled up. Don't let them roll down your legs. They may cause decreased blood flow or skin breakdown if they are not kept pulled up and smooth.
• Sequential compression devices (SCDs or "Kendalls") are also used. They are plastic sleeves that wrap around your legs. They stay in place with Velcro. The sleeves are attached to a pump. The pump fills the sleeves with air and gently squeezes the leg, squeezing from ankle to calf to thigh. These help the circulation in the legs.

Before you leave for the operating room, your nurse will be sure you have:

• Brushed your teeth and bathed. Emptied your bladder. Put on a hospital gown. Removed your underwear.
• Removed nail polish, hairpins, jewelry, makeup, glasses, contacts, hearing aids and dentures/partials.

Where do my family/friends wait while I am in surgery?
Your family should wait in the Day of Surgery Lounge. It is located on the 6^th floor near Elevator H. There are volunteers there to greet them. Your family should let the volunteers know if they need anything, have questions or if they leave the area. When the operation is over, the surgeon will look for your family members in the Day of Surgery Lounge to discuss your surgery.

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