Man Undergoes Life-Changing Surgery at Cleveland Clinic London

Richard Tufano's life has been transformed over the past year and a half. In February 2023, he became the first patient at Cleveland Clinic London to undergo a minimally-invasive oesophagectomy for achalasia, a rare and debilitating swallowing disorder that had plagued him for years. Richard's severe indigestion, constant difficulty swallowing, and the sensation of food being stuck in his throat were once daily challenges.

"I initially thought it was caused by poor eating habits, like eating late at night," Richard recalls. "But it got so bad I couldn't eat without drinking copious amounts of water, and I'd frequently cough up food." His wife also observed that he regularly coughed while sleeping.

“She encouraged me to get checked out,” says Richard.

Doctors recommended an endoscopy (a minimally invasive technique for diagnosing and treating digestive concerns that uses a thin, flexible tube with a camera attached that is passed down the oesophagus). After two failed attempts at endoscopy due to food blockages in his throat, Richard was referred to Mr Sacheen Kumar, a leading Upper Gastrointestinal Surgeon at Cleveland Clinic London.

“Richard’s case was one of the most severe cases of achalasia I have ever seen,” says Mr. Kumar, who performed comprehensive tests to rule out oesophageal cancer. These tests confirmed that Richard had end-stage achalasia, with his oesophagus severely dilated and at risk of causing massive aspiration into his lungs.

Because of the late stage of his disease, Mr. Kumar discussed Richard’s case in the Cleveland Clinic Complex Benign Upper Gastrointestinal Multidisciplinary meeting and it was decided that there was only one viable option: an oesophagectomy, which involved removing part or all of Richard's oesophagus and transposing his stomach into his chest.

“Despite the enormity of the procedure, Richard was young and healthy, and I knew it would significantly improve his quality of life,” says Mr. Kumar.

Initially scheduled for December 2022, the surgery was delayed when Richard tested positive for COVID.

“The psychological side effect of delaying the surgery was tough,” says Richard. “I had mentally prepared myself, my wife and three children. My boss was coming from Los Angeles to cover my position during the time I would be spending in hospital and in recovery post operation. But the silver lining was I got to spend Christmas at home with my family, albeit feeling rather unwell.”

On the day of surgery in February 2023 Richard felt ready. Mr. Kumar and his team ensured Richard was well-prepared and supported throughout the process. The surgery took 9-hours due to the extent of Richard’s oesophageal damage and involved a complex "pull-up" procedure. The first part was done laparoscopically to mobilise the stomach, followed by major thoracic surgery to remove the dilated oesophagus and connect the stomach to the oesophagus with a join, hand-stitched by Mr. Kumar.

Post-surgery, Richard spent a total of two weeks in the hospital. He was reviewed every day by a Consultant from the Upper GI Surgery team, all of whom have expertise in managing patients with complex upper gastrointestinal conditions.

“The care I got throughout was amazing. Multiple people came in to help me. I had regular check-ins and support from dietitians, physiotherapists and nurses,” he says. “Even after I was discharged, my nurse was readily accessible to me by phone to answer any questions.”

The transition from liquids to soft foods marked a significant milestone in his recovery, and he was soon able to enjoy normal foods with minimal discomfort. After 10 weeks, his feeding tube, which had been placed temporarily in case he wasn’t able to eat by mouth, was removed.

“I no longer experienced reflux, regurgitation or night-time coughing, and my sleep improved,” Richard states.

Today, Richard continues to see Mr. Kumar every three months, ensuring any potential issues are addressed promptly – a testament to Cleveland Clinic London’s commitment to long-term patient well-being.

Reflecting on his journey, Richard says Mr. Kumar’s expertise, combined with his ability to communicate and empathise, made all the difference.

“In Mr. Kumar’s world these surgeries are fairly routine, in my world this is a life-changing event, so it was the care and approach he took with me that meant everything,” says Richard. “He made me feel confident that the surgery would be successful, and I would be able to recover and have a good life.”