The esophagus is an important organ that moves food into the stomach. If it needs to be removed due to illness, doctors have options to replace it. Those affected can then eat independently again – but with restrictions.

Actor Heinz Hoenig (72) has had surgery. The operation, which lasted several hours on Monday, was successful, his management said at the request of the German Press Agency. A bacterial infection had caused a hole in his esophagus. Doctors are now said to have removed the organ.

Without an esophagus, Hoenig must first be fed through a tube. A tube usually runs through the nose directly into the stomach. It is also possible for patients without an esophagus to receive nutrition via an artificial intestinal inlet. Doctors can then replace the missing esophagus in a further operation. There are different possibilities for this.

On the one hand, the stomach can be pulled up so far that a new esophagus is formed from the upper section. However, this only works if the stomach is big enough. If patients are initially fed from a tube for several months, it can subsequently shrink. It may then no longer be large enough to form part of it into an esophagus.

It is then possible to recreate the esophagus from a piece of colon. In an adult, the large intestine measures between one and 1.5 meters. In order to form an esophagus, about 30 centimeters would have to be removed.

However, even with such a repaired esophagus, patients remain impaired. Because a replacement does not have the same properties as a real esophagus. For example, it lacks what experts call “peristalsis”: the muscle movement that allows food to be transported towards the stomach against gravity. This means that healthy people can also eat and drink overhead. This doesn’t work with an esophagus replica.

Possible lasting symptoms can also include nausea, stomach pain, frequent diarrhea and intestinal cramps. Most of those affected have to eat porridge for the rest of their lives or cut the food as small as possible and drink a lot to get it through to the stomach as best as possible.

If the esophagus was formed from part of the stomach, it has less volume as a result. Patients must relearn when to stop eating to prevent nausea and intense bloating. Splitting meals into several small portions eaten throughout the day can help.

It is advisable to lie elevated at night to avoid reflux. Stomach acid rises into the esophagus and causes an unpleasant burning sensation.

At the beginning of May, Heinz Hoenig was put into an artificial coma. A bacterial infection damaged a stent that Hoenig had been wearing since 2012. For example, stents are placed in cases of circulatory problems in the coronary arteries in order to make the narrow areas more permeable. The bacteria are also said to be responsible for the hole in the esophagus.

“There are days when I have to deal with nausea two to three times a day and, on the other hand, there are longer phases without symptoms,” says Stefan J. on the website of the esophageal diseases self-help group at the University Hospital of Cologne. In his case, the esophagus was removed in 2013 due to a malignant tumor and replaced with a “stomach pull-up”.

“It can also cause diarrhea, exhaustion, sweating, (trembling), pain, a feeling of fullness and difficulty breathing, etc. The higher position of the stomach, the transformation of the stomach into a tube and also the changed muscle movement of the stomach are changes that contribute to these complaints,” reports Stefan J. further.

Changing your eating habits can be “a little annoying”. In his case, this includes: “eating smaller portions, including snacks, avoiding certain foods, not drinking carbonated drinks, not eating and drinking at the same time, eating slowly and chewing everything well, not eating too late, and so on…”

Surf tip: No health insurance – Why Heinz Hoenig was uninsured – and what 60,000 other uninsured people should learn from it