Postoperative care after long myotomy for DES follows the same principles of care for any noncardiac surgery of the chest. Unique to surgery of the esophagus, however, is a high index of suspicion for unidentified esophageal leak, for this can be a catastrophic complication. Patients are extubated preferably in the OR or postanesthesia recovery room. At our institution, patients are admitted to a step-down thoracic ICU. Attention to pulmonary toilet is essential, and chest physiotherapy, performed at our institution by a thoracic intensive care nurse, is instituted to avoid the complication of atelectasis or sputum retention. The nasogastric tube is placed on low intermittent suction, and the chest tube is set at −20 cm H2O of water-seal suction until the next morning. A barium swallow study is performed on the first postoperative day, and if there is no evidence of leak, the nasogastric tube is removed, and the patient is started on sips of clear liquids. If liquids are well-tolerated, the patient is advanced to a clear liquid diet. There should be no expectation of air leak unless there is a known surgical complication. If the fluid output from the chest tube is low and there is no air leak, the chest tube can be removed on the first postoperative day after the barium swallow. The patient is encouraged to ambulate aggressively on the first postoperative day. Once oral intake is tolerated, oral analgesics are introduced. The epidural is later removed after a small period of overlap with oral analgesics. The length of stay for a thoracoscopic procedure is 3–5 days. Longer stays are required after thoracotomy. The patient is seen again in follow-up 2–3 months after surgery (Fig. 27-9).