Gastro & Liver

GASTROINTESTINAL SURGERY PROCEDURES
EMERGENCY GASTROINTESTINAL SURGERY

  • Acute appendicitis
  • Intestinal perforation (duodenal ulcer, colonic perforations)
  • Life threatening bleeding of the gastrointestinal tract
  • Intestinal obstruction
  • Severe infections of the gall bladder
  • Trauma to the abdominal organs

Gastrointestinal Surgery Procedures

Emergency gastrointestinal surgery
  • Acute appendicitis
  • Intestinal perforation (duodenal ulcer, colonic perforations)
  • Life threatening bleeding of the gastrointestinal tract
  • Intestinal obstruction
  • Severe infections of the gall bladder
  • Trauma to the abdominal organs

Emergency conditions affecting the digestive require emergency surgical intervention. Such conditions need to be managed by performing emergency laparoscopy or explorative laparotomy which involves making an open incision to explore the abdominal organs to treat the emergent problem. Accident and trauma to the abdominal organs may require emergency surgery to stop bleeding or remove the damaged organ (e.g. emergency removal of the spleen)

Acute appendicitis is one of the commonest acute conditions presenting to the emergency department. The standard of care is to remove the infected appendix (appendectomy) which is generally done laparoscopically with excellent outcomes.

Upper gastrointestinal procedures

Surgery for Esophageal cancer – Depending on the stage of the cancer, surgical removal of part of the esophagus offers curative management option. This can be done by laparoscopic or open surgery either through the abdomen (Trans-hiatal) or the chest (trans thoracic).

Stomach cancer – Gastrectomy is a procedure where whole (total gastrectomy) or part (partial / sub-total gastrectomy) of the stomach is surgically removed, generally as a curative procedure for cancer or sometimes benign condition. This can be done either as open or laparoscopic technique.

Fundoplication: It is a procedure to treat severe gastro-esophageal reflux disease (GERD) when maximal medical therapy has failed to improve the symptoms. It is also a procedure recommended for treatment of hiatus hernia.

Para-oesophageal hernia repair: Surgery to repair oesophageal hiatal hernia. This type of hernia occurs due to widening of the gap in the diaphragm through which the oesophagus passes. This procedure can be performed by laparoscopic surgery.

Surgery for Achalasia Cardia – Heller myotomy is a laparoscopic (minimally invasive) surgical procedure used to treat achalasia which is a disorder of the esophagus that makes it hard for foods and liquids to pass into the stomach due to increased tone of the lower oesophageal muscle sphincter.

Esophageal strictures – Esophageal stricture is a narrowing in the esophagus that can be caused either by benign or malignant conditions. Depending on the disorder endoscopic therapy is initially advised and surgical resection (removal) of the affected area is recommended if endoscopic treatment fails.

Gastrojejunostomy – When there is blockage to the outflow of the stomach and curative surgery is not an option, then a part of the small intestine is joined to the stomach to by-pass the blockage.

Small bowel resection – Sometimes, a part of the small intestine may have to be removed due to either malignant or benign disease; or as part of other procedure (for eg. Pancreatoduodenectomy).

Feeding jejunostomy – This is procedure where a feeding tube is placed in the small intestine to facilitate feeding when alternative feeding methods are required either due to advanced disease or after gastric or esophageal surgery to help faster recovery.

Gall Bladder / Bile ducts

  • Laparoscopic Cholecystectomy - Removal of gall bladder for stone disease
  • Radical cholecystectomy - Removal of Gallbladder along with a part of the liver and with lymph nodes for cancer of the Gall bladder.
  • Treatment of Biliary injuries – Usually after difficult Laparoscopic cholecystectomies, injuries to the bile duct can occur. Requires careful management and reconstructions depending on the type and severity of the injury.
  • Common bile Duct exploration for stone disease.
  • Treatment for cancer of the bile duct - Cholangiocarcinoma
  • Bile duct reconstruction for choledochal cysts which are congenital abnormalities of the bile ducts with high potential for complications including cancers of the biliary system.

Pancreatic surgeries –

  • Management of Acute Pancreatitis: Severe Inflammation of the pancreas can sometimes lead to destruction of part of the pancreas which will need surgical removal (necrosectomy).
  • Laparoscopic Cystogastrostomy or Jejunostomy for Pseudocyst of the Pancreas. Usually performed as a laparoscopic procedure.
  • Whipple’s Pancreaticoduodenectomy – Complex surgery for the removal of Pancreatic / duodenal / distal bile duct cancers.
  • Distal Pancreatectomy – for cancers / tumors of the body and tail of the pancreas. Spleen can be preserved in most cases. Laparoscopic surgery is standard of care for most patients.
  • Total Pancreatectomy - involves removal of the whole of the pancreas when it is completely affected by the disease process.
  • Pancreato-jejunostomy for Chronic calcific pancreatitis – Can provide significant pain relief and improved quality of life for these patients.
  • Splenectomy – Lap / robotic – for various disorders mostly hematological indications.

Colon and rectal surgeries-

Segmental colonic resections or colectomy: Colectomy is surgical removal of part of the large intestine or the colon. The indications for doing this procedure would be cancer, inflammatory bowel disease, diverticulitis, ischemia (loss of blood supply to the bowel) or life-threatening infections. Depending on the part of the colon removed, there can be a right or left colectomy or sigmoid colectomy. The ends of the intestine remaining are joined together to restore continuity of the tract. In some instances where the ends of the bowel cannot be joined either due to severe inflammation or infection, then one end of the bowel is brought out through the abdominal wall as a stoma. In majority of the cases, this would be a temporary measure and can be reversed at a later date.

Total proctocolectomy: In severe cases where most of the colon is involved with disease, a subtotal colectomy or a total proctocolectomy (colon + rectum) is performed. In subtotal colectomy, the end of the small bowel is joined to the top of the rectum to restore continuity. In a total proctocolectomy a permanent stoma (Colostomy) is fashioned or restorative procedure can be performed where in the small bowel is fashioned in to a pouch (Ileal pouch) and joined to the anal canal in such a way so as to act like reservoir for the faeces, thereby avoiding a stoma.

Resection of rectum: The procedure for surgical removal of part of the rectum is called anterior resection. Depending on the level where the rectum is cut, it can be divided in to a high or a low anterior resection. When the tumour is close to the anal passage, an ultra-low anterior resection can be performed which will preserve the anal sphincter muscles that are essential for faecal continence.

Rectopexy (for rectal prolapse): This a procedure for treating prolapse of the rectum. Rectal prolapse occurs when the pelvic floor muscles are weak and part of the rectum prolapses out through the anal passage. There two ways of surgically treating this. It can be done through the abdomen (Laparoscopically) where the rectum is supported with insertion of a mesh or through the perineum, where the surgery is performed through the anal passage.

Ano-Proctology: Conditions affecting the anal passage and lower part of the rectum include Hemorrhoids, anal fistulas and Anal fissure. Haemorrhoid treatment that can be offered are stapled haemorrhoidectomy (PPH), HALO (Haemorrhoidal Artery Ligation Operation) and conventional haemorrhoidectomy. For fistula-in-ano, depending on the involvement of the anal sphincter muscles, choice of procedures includes fistulotomy (laying open), fistulectomy (removing the fistula tract), seton insertion (inserting a thread through the fistula tract), LFT (Ligation of Intersphincteric Fistula Tract) etc. Anal fissure is a very painful condition and surgical treatment is advised when medical therapy fails to cure it. Fissurectomy (removal of the fissure) or lateral sphinchterotomy (dividing part of the internal anal sphincter) can be performed to help cure it.

Abdominal wall hernia

Surgical treatment of abdominal wall hernia: Hernias of the abdominal wall including the groin area can only be treated definitively with surgical intervention. Hernias can occur either through weakness of the musculature or at sites of previous surgical incisions (Incisional hernias). Laparoscopic repair with a prosthetic mesh is the standard treatment for these conditions.

Obesity Surgery

Surgery for weight loss or also called bariatric surgery involves making surgical changes to your stomach and digestive system that limit how much food you can eat and how many nutrients you absorb, leading to weight loss. It also helps prevent or cure other obesity related problems like diabetes, high blood pressure and improve the quality of life. There are two common surgical procedures.

  • Sleeve gastrectomy: About 80% of the stomach is removed, thus reducing the capacity of the stomach.
  • Gastric bypass: In this procedure, the stomach is divided into a small pouch and the small intestine is “rearranged” to connect to this small stomach pouch. The food thus bypasses the stomach thereby reducing the capacity and absorption of nutrients causing weight loss.