Gastroenterologic surgery includes a variety of surgical procedures performed on the organs and conduits of the digestive system. These procedures include the repair, removal, or resection of the esophagus, liver, stomach, spleen, pancreas, gallbladder, colon, anus, and rectum. Gastroenterologic surgery is performed for diseases ranging from appendicitis, gastroesophageal reflux disease (GERD), and gastric ulcers to the life-threatening cancers of the stomach, colon, liver, and pancreas, and ulcerative conditions like ulcerative colitis and Crohn's disease.
Some prominent surgical procedures included in gasteroentologic surgery are:
- Fundoplication to prevent reflux acids in the stomach from damaging the esophagus.
- Appendectomy for removal of an inflamed or infected appendix.
- Cholecystectomy for removal of an inflamed gallbladder and the crystallized salts called gallstones.
- Vagotomy, antrectomy, pyloroplasty are surgeries for gastric and peptic ulcers, now very rare. In the last 10 years, medical research has confirmed that gastric and peptic ulcers are due primarily to Heliobacter pylori, which causes more than 90% of duodenal ulcers and up to 80% of gastric ulcers. The most frequent surgeries today for ulcers of the stomach and duodenum are for complications of ulcerative conditions, largely perforation.
- Colostomy,ileostomy, and ileoanal reservoir surgery are done to remove part of the colon by colostomy; part of the colon as it enters the small intestine by ileostomy; and removal of part of the colon as it enters the rectal reservoir by ileonal reservoir surgery. These surgeries are required to relieve diseased tissue and allow for the continuation of waste to be removed from the body. Inflammatory bowel disease includes two severe conditions: ulcerative colitis and Crohn's disease. In both cases, portions of the bowel must be resected. Crohn's disease affects the small intestine and ulterative colitis affects the lining of the colon. Cancers in the area of the colon and rectum can also necessitate the resection of the colon, intestine, and/or rectum.
The need for surgery of the esophagus, duodenum, stomach, colon, and intestines is assessed by medical history, general physical, and x ray after the patient swallows barium for maximum visibility. Diagnosis and preparation for gasteroentological surgery involve some very advanced techniques. Upper and lower gastrointestinal endoscopies are more accurate in spotting abnormalities than x ray and can be used in treatment.
Endoscopy utilizes a long, flexible plastic tube with a camera to look at the stomach and bowel. Quite often, physicians will also use a CT scan for procedures like appendectomy. Upper esophagogastroduodenal endoscopy is considered the reference method of diagnosis for ulcers of the stomach and duodenum. Colonoscopy and sigmoidoscopy are mandatory for diseases and cancers of the colon and large intestine.
For simple procedures like appendectomy and gallbladder surgery, patients stay in the hospital the night of surgery and may require extra days in the hospital; but they usually go home the next day. Postoperative pain is mild, with liquids strongly recommended in the diet, followed gradually with solid foods. Return to normal activities usually occurs in a short period. For more involved procedures on organs like stomach, bowel, pancreas, and liver, open surgery usually dictates a few days of hospitalization with a slow recovery period.
The risks in gastroenterologic surgery are largely confined to wounds or injuries to adjacent organs; infection; and the general risks of open surgery that involve thrombosis and heart difficulties. With some laparoscopic procedures such as fundoplication with injury or laceration of other organs, the return of symptoms within two to three years may occur. With appendectomy, the rates of infection and wound complications range between 10–18% in patients.
The institution of new clinical practice guidelines that include wound guidelines and directed management of postoperative infectious complications are substantially reducing patient mortality. Gallbladder surgery, especially laparoscopic cholecystectomy, is one of the most common surgical procedures in the United States. However, injuries to adjacent organs or structures may occur, requiring a second surgery to repair it. Stomach surgical procedures carry risks, generally in proportion to their benefits. Today, surgery for peptic ulcer disease is largely restricted to the treatment of such complications as bleeding for ulcer perforation.
Recent research indicates that surgery for bleeding is 90% effective using endoscopic techniques. Laparoscopic surgery for ulcer complications has not been found to be better than regular surgery. Stomach and intestinal surgery risks include diarrhea, reflux gastritis, malabsorption of nutrients, especially iron, as well as the general surgical risks associated with abdominal surgery. The risks of colon surgery are tied to both the general risks of surgical procedures—thrombosis and heart problems—and to the specific disease being treated. For instance, in Crohn's disease, resection of the colon may not be effective in the long run and may require repeated surgeries. Colon surgery in general has risks for bowel obstruction and bleeding.
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