Surgical Gastroenterology - An Exploration of Treatment Approaches and Surgical Techniques

The human body’s digestive system resembles a complex symphony of organs that collectively form the gastrointestinal system. It is responsible for processing food and absorbing nutrients, ensuring our body receives the nourishment it needs to thrive. However, numerous factors including genetic, lifestyle, and environmental can disrupt the delicate harmony of the GI system, leading to issues that may require medical and surgical intervention. Read on to delve into the diverse spectrum of surgical gastroenterology, exploring a range of surgical gastroenterology procedures that have revolutionised the treatment of digestive disorders and gastrointestinal conditions.

Surgical gastroenterology

Conditions that require GI surgery include:

• Appendicitis
• Colon cancer
• Gallbladder disorders
• Hiatal hernia
• Rectal prolapse
• Liver disorders
• Gastrointestinal cancer
• GI bleeding
• Diverticular disease

Surgical gastroenterology techniques

Throughout the centuries, surgical gastroenterology has seen remarkable growth, evolving from exploratory open surgeries to minimally invasive methods. There are various techniques used today that have revolutionised the way we approach ailments of the GI tract. The most commonly implemented procedures that are relevant to date are:

1.Open surgery: A large cut is used to open the surgical site and is certainly an invasive procedure. Longer surgical hours, bigger scars, more post-op pain and recovery time are considered downsides. However, certain complex surgeries necessitate this method for a successful outcome.

2.Laparoscopy: Smaller cuts are made to approach the surgical site and the surgery is performed using an instrument called a laparoscope (thin flexible tube with a lighted camera). Most of the treatments have evolved to adopt this minimally invasive method to ensure lesser pain, smaller scars and quicker recovery, making it the most sought after surgical gastroenterology approach.

3.Endoscopy: It is a procedure where a long thin tube with a camera, called an endoscope is inserted in the natural openings of the body like the mouth. Its benefits lie in the ability to offer real time imaging, detection of abnormalities, and targeted biopsies, making it an invaluable tool for diagnosis and timely intervention.

4.Robotic surgery: This advanced technique incorporates using a computerised system to perform intricate procedures. It involves using robotic arms controlled by a skilled surgeon to carry out precise movements to enhance dexterity and range of motion. By leveraging high-definition 3D imaging and specialised equipment, robotic surgery offers the benefits of a minimally invasive procedure with improved surgical outcomes.

Types of GI surgeries

Surgical gastroenterology is a vast topic encompassing many procedures that treat various conditions. From the routine appendectomy to the complex resection of gastrointestinal tumours, these surgeries demand skill, precision, and a deep understanding of the intricacies of the human body.

Find a list of GI surgeries done using minimally invasive techniques.

• Appendectomy: It is the surgical removal of the appendix, performed as a procedure to treat acute appendicitis, a condition characterised by the inflammation of the appendix.
• Adrenalectomy: It involves the surgical removal of one or both adrenal glands, which are responsible for producing essential hormones to treat conditions like Cushing's/Conn’s syndrome and adrenal gland tumours.
• Bariatric surgery: It is a group of surgical weight loss procedures for individuals with severe obesity that involves altering the digestive system to achieve significant and sustained weight loss.
• Cholecystectomy: It is the surgical removal of the gallbladder typically performed in case of gallstones or other gallbladder disorders, providing pain relief and preventing potential complications.
• Hiatal hernia repair: It involves addressing a condition called hiatal hernia where a part of the stomach protrudes into the chest through the diaphragm. It is often coupled with another procedure called Nissen fundoplication to alleviate GERD (Gastroesophageal reflux disorder or chronic heartburn) which is associated with hiatal hernia.
• Nephrectomy: It's the surgical removal of one or both kidneys, often performed to treat kidney cancer, severe organ damage, kidney donation or transplantation procedures.
• Splenectomy: this surgical procedure is aimed at removing the spleen, often carried out to address conditions such as enlarged spleen, traumatic injuries, or certain blood disorders.
• Pancreatic surgery: It encompasses various diseases pertaining to the pancreas including pancreatitis, drainage of pancreatic cysts, pancreatic cancer, etc.
• Retroperitoneal surgery: The name denotes the surgeries performed on organs located behind the peritoneum such as kidneys, adrenal glands, and lymph nodes. However, it is mostly attributed to the treatment of testicular cancer.
• Colon and rectal surgery: This term is collectively implied for procedures related to conditions of the large intestine (colon, rectum, and anus), including colorectal cancer resections, diverticulitis treatment, haemorrhoid removal, and colonoscopy.

Some conditions cannot be treated with a minimally invasive approach and require open surgeries, such as:

Open appendectomy: Open appendectomy is a surgical procedure involving a single large incision on the lower right abdomen to remove the inflamed appendix. It is typically an emergency procedure that allows direct access to the affected area when laparoscopic techniques are not suitable.

Open adrenalectomy: Here the surgeon makes a large incision on the abdomen or back to access and removes the adrenal gland(s). This method is employed for large tumours and complex cases providing a better view and control during the surgery.

Nissen fundoplication: This open surgery is used to treat GERD. It involves wrapping the upper part of the stomach - fundus, around the lower oesophagus to reinforce the lower esophageal sphincter and prevent acid reflux.

Roux-en-Y: This procedure is commonly used in bariatric surgery to create a connection between the early part of the stomach and the small intestine, bypassing a portion of the stomach and duodenum.

Whipple procedure: Also known as pancreaticoduodenectomy, it is a complex open surgery performed to treat certain pancreatic, bile duct, and duodenal cancers. It involves the removal of the head of the pancreas, duodenum, gallbladder and sometimes part of the stomach followed by reconnection to the remaining organs to restore digestion.

How to prepare for the surgery?

After arriving at a confirmatory diagnosis, your doctor will devise a customised treatment plan for you. Based on the complexity, surgical gastroenterology requires a multidisciplinary approach where collaborations between gastroenterologists, surgeons, oncologists, radiologists, and other healthcare professionals are essential to devise comprehensive treatment plans tailored to each patient's unique condition.

Pre-surgery preparation in gastroenterology involves several essential steps to ensure optimal patient outcomes. Follow every step as advised.

Usually, you would be subjected to a preparatory diet and asked not to drink or eat anything before the surgery. Additionally, you may need to discontinue certain medications that could interfere with the procedure or recovery. Pre-operative assessments and tests are conducted to evaluate the overall health and identify any potential risks. You would be educated about the surgery, expected outcomes, and post-operative care to alleviate anxiety and encourage active involvement in the healing process of surgical gastroenterology.

Risks and complications associated with surgical gastroenterology

Any surgical procedure is often associated with risks although proper care is ensured. These risks include pre-op and post-op complications. The probability is however minimal when done in a sterile environment by a skilled professional. And, as it takes two to tango, one can eliminate some of the post-op complications by strictly adhering to the doctor’s instructions.

The following GI complications can be anticipated with surgical gastroenterology.

• 1.Bile leakage
• 2.Infection at the surgical site
• 3.Sepsis and septic shock lead to organ failures
• 4.Intra abdominal bleeding
• 5.Accidental damage to healthy tissues
• 6.Pneumonia
• 7.Urine retention
• 8.Urinary tract infection
• 9.Deep venous thrombosis (DVT)
• 10.Gastrointestinal cancer
• 11.Pulmonary embolism
• 12.Reactions to anaesthesia

Post-op care

Recovery time would depend on the surgical method followed and its level of invasiveness. With a simple procedure like an endoscopy or colonoscopy, you should be on and about with your work as soon as the procedure. Laparoscopic procedures will need less time than open surgeries which demand more time for healing and recovery.

Post-operative surgical gastroenterology care involves closely monitoring the patient's vital signs, pain levels, and incision sites to detect any signs of complications or infections. You are typically encouraged to begin moving and walking as soon as possible to prevent blood clots and aid in the recovery process. Additionally, a carefully managed diet is introduced gradually to allow your gastrointestinal system to heal and function properly after the surgery.

Bottom line

Hope this blog enlightened you on the various approaches and techniques in surgical gastroenterology. A whole rounded discussion on what to expect before and after the surgery has also been a focal point to feed your curiosity in understanding the intricacies of surgical gastroenterology. Knowing this will give you an upper hand when it comes to choosing the right doctor which is crucial.

Surgical gastroenterology’s ingenuity continues to transform lives. So, if you or your kin and kith need surgery, be rest assured that yours will be transformed too.

Contact www.lcubelife.com to book an appointment with Dr. Joy Varghese, one of India's premier experts in transplantation Hepatology who has managed more than 1500 liver transplantations successfully.