Gastrointestinal Surgery

Gastrointestinal (GI) system is one of the important organ systems and is associated in digestion, absorption and excretion of food providing energy to our body. Various conditions may affect the normal functioning of GI system and may lead to further complications. Gastro-intestinal surgery is the surgical subspecialty that involves treatment of any injury, deformity and disease of the gastrointestinal system with operative procedures. It is considered as an option when medications can no longer alleviate your condition. The common gastrointestinal conditions treated with surgery include appendicitis, pancreatitis, hernias, gallbladder disorders, and stomach and intestinal disorders.

Some of the general surgical procedures are as follows:

 

Appendicectomy

Appendicectomy is the surgical removal of the appendix and is the most common procedure. A 3–6 cm horizontal incision is made in the lower part of the abdomen on the right side, through which the appendix is removed. Alternately, the appendix can be removed by a keyhole operation or the insertion of a three-fibre optic camera through the stomach (laparoscopy).

 

Cholecystectomy

Cholecystectomy is performed to remove the gallbladder in patients with symptomatic gallstones. In open surgical procedure of cholecystectomy, an incision (approximately 10-15cm) is made in the right upper abdomen. Laparoscopic cholecystectomy is an invasive technique to remove the gallbladder where small incisions rather than larger incision are made in the abdomen. Surgery is performed using laparoscope, a small thin tube instrument attached with tiny camera and lens that enables a view of the inner area on a larger screen, and surgical instruments through these incisions.

 

Oesophagectomy

The oesophagus (gullet) is the hollow muscular tube that carries food from the mouth down into the stomach. Oesophageal cancer is a malignant cancer that affects the tissues lining the oesophagus. It can occur in any part of the oesophagus. Treatment for oesophageal cancer aims at destroying these cancerous cells. Surgery is the most common treatment for oesophageal cancer.

Oesophageal cancer surgery aims at curing cancer by surgically removing the whole (total oesophagectomy) or part of the oesophagus (oesophagectomy) and the surrounding tissue that is affected. The left-out oesophagus is then re-attached to the stomach after pulling it into the chest. When the whole of the oesophagus is removed, the whole stomach is pulled up into the chest and is used to replace the oesophagus. Sometimes a portion of the large intestine is cut and surgically attached to replace the oesophagus. To reduce the risk of recurrence of cancer, lymph nodes from the surrounding area are also removed (lymphadenectomy). In case the cancer spreads to the stomach, the upper part of the stomach is removed along with part of the affected oesophagus (oesophago-gastrectomy).

Surgery for oesophageal cancer can be done by either an open approach or by a minimally invasive approach using laparoscopy (minimally invasive oesophagectomy). In certain cases it becomes necessary to switch from minimally invasive to open approach depending on the situation. The type of the approach depends on the situation and is decided by the surgeon.

In an open approach a large incision is made on the neck, chest or tummy depending on the location of the cancer, and the required procedure is done. In a laparoscopic approach the surgery is done in two parts. First the portion of the affected oesophagus is removed laparoscopically through 3-4 small incisions in the chest. The surgeon can view the image on the monitor provided by the camera on the laparoscope inserted through one small hole in the chest during the surgery. The stomach is then re-attached to the oesophagus either through a large incision or by laparoscopy. Laparoscopic approach is less invasive and thus leads to less pain and fewer complications.

The major complications of the surgery may include pneumonia and leaking of digestive fluids at the place where the stomach is attached to the remaining oesophagus. Surgery in severe cases of oesophageal cancer is mostly done after chemotherapy and radiation therapy.

 

Gastrectomy (Removal of part of or whole of the stomach)

  • Partial gastrectomy: this is where a very limited section of the stomach is removed, rarely for benign ulcer disease and more commonly nowadays for tumours other than adenocarcinoma of stomach such as gastrointestinal stromal tumours. This is usually performed using keyhole surgery.
  • Subtotal gastrectomy: this is where more than half of the stomach is removed. This is usually done via an abdominal incision and involves removal of the surrounding lymph nodes. In some cases this may be able to be done with laparoscopic surgery.
  • Total gastrectomy: this is where all of the stomach and surrounding lymph nodes are removed. Occasionally, other organs such as the spleen need to be removed as well.

 

Surgery for Achalasia

Achalasia forms part of the rare functional disorders of the gullet where the lower part cannot relax normally, leading to vomiting and difficulty in eating and swallowing. After appropriate investigations including radiological endoscopic and manometric (pressure tests), treatment includes stretching with a specific balloon done at gastroscopy and/or laparoscopic surgery to cut the lower oesophageal muscle and relax the sphincter to allow passage of food and fluids (Myotomy). This procedure is usually done in conduction with an anti reflux procedure at the same time.

 

Small intestine resection/surgery

This may include surgery for small bowel tumours – these tumours are rare and include cancers as well as neuroendocrine tumours. Surgery may involve removal of the tumour and the involved bowel as well as the associated lymph nodes. More commonly surgery for bowel obstruction is performed – there are a number of causes for bowel obstruction.

The small bowel is most commonly obstructed because of adhesions related to previous surgery. Surgery is sometimes required to relieve the obstruction. This may be done using keyhole surgery. A significant proportion of the small intestine may be resected without major nutritional or functional problems.