Upper Gastrointestinal Surgery

Overview

Upper gastrointestinal (GI) surgery is performed to address disorders of the small bowel, gall bladder, liver, pancreas, or esophagus.

The oesophagus (food pipe), duodenum (initial section of the small intestine), and stomach comprise the upper gastrointestinal (GI).

If a patient has symptoms such as bloating, stomach discomfort, heartburn, swallowing difficulty, or acid reflux, a doctor may propose upper gastrointestinal (GI) surgery. To determine the underlying problems, the condition is initially investigated utilizing diagnostic procedures.

Symptoms that may prompt someone to consider upper gastrointestinal (GI) surgery include: stomach inflammation, gastritis or duodenum, H.pylori infection, gastroesophageal reflux disease (GERD), and peptic ulcers (sores). Tumors in the stomach or esophagus can produce symptoms. Depending on the location and stage of the cancer, surgery may be required for treatment and management.

 

What Upper Gastrointestinal Surgery Can Treat?

Doctor care for routine and rare conditions of the stomach, oesophagus and small bowel, including:

1. Barrett’s oesophagus: Barrett's esophagus is a disorder in which acid reflux damages the flat pink lining of the swallowing tube that links the mouth to the stomach (esophagus), causing it to thicken and become red. The lower esophageal sphincter is a vital valve located between the esophagus and the stomach (LES). The LES may eventually fail, causing acid and chemical damage to the esophagus, a condition known as gastroesophageal reflux disease (GERD). GERD is frequently associated with symptoms such as heartburn or regurgitation. This GERD may cause a change in the cells lining the lower esophagus in certain persons, resulting in Barrett's esophagus. Barrett's esophagus is linked to an increased risk of esophageal cancer. Although the chance of getting esophageal cancer is low, yearly checks with thorough imaging and extensive biopsies of the esophagus to look for precancerous cells are recommended (dysplasia). Precancerous cells can be treated to avoid esophageal cancer if they are identified.
2. Gastrointestinal stromal tumour (GIST): GIST (gastrointestinal stromal tumor) is a kind of cancer that starts in the digestive tract. GISTs are most commonly seen in the stomach and small intestine. A GIST is a cell growth that is thought to arise from a certain type of nerve cell. These unique nerve cells can be found in the walls of the digestive organs. They contribute to the movement of food through the body. Small GISTs may not create symptoms and may develop so slowly that they present no difficulties at first. A GIST can create indications and symptoms as it develops.
3. Gastro-oesophageal reflux disease (GORD): Gastro-oesophageal reflux disease (GORD) is a frequent disorder in which stomach acid flows into the oesophagus (gullet). It generally happens when the ring of muscle at the bottom of the oesophagus weakens. Learn more about GORD's causes. GORD symptoms include heartburn and a bad taste in the back of the mouth. For some, it may be a little nuisance, but for others, it can be a severe, life-long issue. GORD is frequently treatable with self-help and medication. Surgery to fix the condition is sometimes required.
4. Hiatal hernia: When the top region of your stomach bulges through the big muscle that separates your abdomen and chest, you have a hiatal hernia (diaphragm). A tiny gap (hiatus) in your diaphragm allows your food tube (esophagus) to pass before joining to your stomach. The stomach rises up through that gap and into your chest in a hiatal hernia. A minor hiatal hernia normally causes no difficulties. You might not even be aware you have one unless your doctor detects it when testing for another ailment. A big hiatal hernia, on the other hand, can allow food and acid to back up into your esophagus, causing heartburn. Usually, self-care or medicine can relieve these symptoms. A big hiatal hernia may necessitate surgery.
5. Oesophageal strictures: An esophageal stricture is a tightness or constriction of the esophagus that is not normal. The esophagus is a muscular tube that links your neck to your stomach and transports food and drink. A stricture narrows the esophagus, making food transit through the tube more difficult. Even ingesting liquids might be challenging in extreme situations. Esophageal strictures can be:

• • • Cancerous: These strictures get worse quickly.
    • Benign (not cancerous): Benign strictures tend to progress slowly

    6. Stomach cancer: In stomach cancer, also known as gastric cancer, cancer cells proliferate uncontrollably in the stomach. Cancer         can develop in any part of your stomach. The majority of stomach cancer instances in the United States involve abnormal cell           development at the junction of your stomach and esophagus (gastroesophageal junction). Cancer normally starts in the major           area of your stomach in other nations where gastric cancer is more frequent. Approximately 95% of the time, stomach cancer           begins in the lining of your stomach and grows slowly. If left untreated, it can develop into a mass (tumor) and penetrate                 further into your stomach walls. The tumor might spread to adjacent organs such as your liver or pancreas.

    7. Esophageal cancer: Esophageal cancer is a type of cancer that develops in the esophagus, which is a long, hollow tube that             connects your throat to your stomach. Your esophagus aids in the movement of food from the back of your throat to your               stomach for digestion. Esophageal cancer typically originates in the cells that lining the esophagus. Esophageal cancer can               develop at any point along the esophagus. Esophageal cancer affects males more than women. Esophageal carcinoma is the             world's sixth leading cause of cancer mortality. The incidence rate varies by geographic area. Tobacco and alcohol use, as well           as certain food habits and obesity, may be linked to greater risks of esophageal cancer in specific areas.

    8. Stomach ulcers and peptic ulcers: Peptic ulcers are open sores that develop on the inside lining of your stomach and the               upper portion of your small intestine. The most common symptom of a peptic ulcer is stomach pain. Peptic ulcers include:

• • • Gastric ulcers that occur on the inside of the stomach.
    • Duodenal ulcers that occur on the inside of the upper portion of your small intestine (duodenum).

The most common causes of peptic ulcers are infection with the bacterium Helicobacter pylori (H. pylori) and long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Stress and spicy foods do not cause peptic ulcers. However, they can make your symptoms worse.

     9. Achalasia: Achalasia is a rare disorder that makes it difficult for food and drink to flow from your mouth into your stomach via          the swallowing tube linking your mouth and stomach (esophagus).

Achalasia develops when esophageal nerves are injured. As a result, the esophagus gradually gets paralyzed and dilated, finally losing its capacity to press food down into the stomach. Food then accumulates in the esophagus, occasionally fermenting and washing back up into the mouth, where it might taste bitter. Some individuals confuse this with gastroesophageal reflux disease (GERD). However, in achalasia, food enters the esophagus, but in GERD, food enters the stomach.

 

How to Prepare?

Your practitioner will get imaging tests prior to your operation to assist plan your treatment. Non-invasive diagnostics and images acquired with an endoscope are examples of this. You will also undergo blood tests, such as a complete blood count (CBC), to check for anemia.

You will require an electrocardiogram (EKG), a chest X-ray, and a blood chemistry check before surgery and anesthesia. Medical concerns such as anemia or aberrant electrolyte levels (such as changed calcium or potassium) may need to be addressed before your operation.

Your healthcare provider will also discuss the surgical technique with you and will explain whether you will have a surgical incision and a post-operative scar.

 

Location:

An open laparotomy or laparoscopic procedure would be performed in an operating room in a hospital or surgical center.

An endoscopic surgery would be done in an operating room or a procedural suite, either of which could be in hospital or surgical center.

 

What to Wear?

You should dress comfortably for your surgical appointment. Make sure you have clothing with a loose waist to wear on your journey home.

Furthermore, if you are having laparoscopic surgery, you may have a surgical drain, therefore it is best if you wear clothes that provide easy access to your abdominal area (avoid a dress; consider wearing a loose shirt or one with buttons).

 

Food and Drink

You will need to fast from eating and drinking after midnight the night before your surgery.

 

Medications

In the days or weeks leading up to your peptic ulcer surgery, your healthcare professional may modify some of your medications. For example, you may be told to adjust your dose or discontinue blood thinners. You may also need to change the dose of anti-inflammatory drugs, diabetic medications, or peptic ulcer disease therapies you are taking.

 

What to Bring?

You should bring a form of personal identification, your insurance information, and a method of payment to your surgery appointment if you are responsible for paying for any or all of the cost of your operation.

You should also have someone accompany you who can drive you home because you will be unable to drive for at least a few days following your procedure.

 

Pre-Op Lifestyle Changes

Before your surgery, your healthcare provider will advise you to avoid smoking and drinking alcohol so that your ulcer is not further irritated. You might also be instructed to avoid eating things that can exacerbate a peptic ulcer, such as spicy or acidic foods.

 

What to Expect on the Day of Surgery?

When you arrive for your surgical appointment, you will sign a permission form and register. You may be subjected to certain pre-operative tests before going to the pre-surgical area. A chest X-ray, CBC, blood chemistry panel, and urine test may be performed.

You will be required to put on a hospital gown. Your temperature, blood pressure, pulse, respiratory rate, and oxygen level will all be measured.

If you are undergoing stomach ulcer surgery due to an emergency, such as a perforation, your preparation will be expedited. During this time, you will require IV fluids and maybe a blood transfusion.

 

Before the Surgery

Before your surgery begins, you will get specialized preparation and anesthetic according on the type of procedure you are having.

• IV sedation. It is utilized during an endoscopic treatment. The anesthetic medication will be administered into your IV to make you asleep during this sort of anesthesia. From start to end, your pulse, blood pressure, respiratory rate, and oxygen level will be monitored. You may nod off before or during your procedure. Additionally, if an endoscope is being inserted in your mouth, oral anesthetic medication (typically in the form of a spray) will be given to alleviate any discomfort.
• General anesthesia. If you are undergoing an open laparotomy or a less invasive laparoscopic procedure, this is employed. General anesthesia is the administration of an IV anesthetic medication that will put you to sleep, numb your sensations, and keep you from moving. You would have a tube implanted in your throat for this sort of anesthetic so that you could breathe with artificial aid throughout your surgery.

A drape will be placed across your body if you are undergoing an open laparotomy or a minimally invasive laparoscopic operation. Where the incision will be made, a little piece of your skin will be revealed. Before the operation, your skin will be cleaned.

These procedures are not required prior to endoscopic stomach ulcer surgery.

 

What Procedures Do Upper GI Surgeons Perform?

Upper GI surgeons have a large number of procedures and operations they perform. Some of these include:

Endoscopy

During an upper endoscopy procedure, you'll be asked to lie down on a table on your back or on your side. As the procedure gets underway:

• Monitors are frequently attached to your body. This lets your medical team to monitor your respiration, blood pressure, and heart rate.
• You may be given sedative medicine. This medicine, administered through a vein in your forearm, helps you relax throughout the endoscopy.
• An anesthetic may be applied in your mouth. An anesthetic spray numbs your neck in preparation for the insertion of the long, flexible tube (endoscope). You may be requested to wear a plastic mouth guard to keep your mouth open.
• The endoscope is then placed in your mouth. As the scope goes down your throat, your physician may urge you to swallow. You may feel some pressure in your throat, but it should not be painful.

You can't talk after the endoscope passes down your throat, though you can make noises. The endoscope doesn't interfere with your breathing.

As the endoscope travels down your esophagus:

• Images are sent to a video monitor in the exam room through a small camera at the tip. This monitor is monitored by your physician to look for anything out of the ordinary in your upper digestive system. If anything unexpected is discovered in your digestive tract, pictures can be obtained for subsequent analysis.
• To expand your digestive tract, gentle air pressure may be supplied into your esophagus. The endoscope may now move freely. It also makes it easier to examine the folds of your digestive system. The additional air may cause pressure or fullness.
• Your provider will pass special surgical tools through the endoscope to collect a tissue sample or remove a polyp. This is done with the help from a video monitor to guide the tools.

When the exam is finished, the endoscope is slowly retracted through your mouth. An endoscopy typically takes 15 to 30 minutes.

 

Gastrectomy

There are two methods for doing a gastrectomy. All procedures are carried out under general anesthesia. This means you'll be in a deep sleep during the procedure and won't be able to feel any pain.

 

Open surgery

A single big incision is used in open surgery. To gain access to your stomach, your surgeon will peel aside skin, muscle, and tissue.

 

Laparoscopic operations

Laparoscopic surgery is the most minimally invasive kind of surgery. Small incisions are made, and specialist equipment is employed. This procedure is less painful and allows for a quicker recovery. It is also known as "keyhole surgery" or "laparoscopy-assisted gastrectomy" (LAG).

Open surgery is typically preferred than LAG. It is a more complex operation with fewer issues.

 

Oesophagectomy

This surgery can be performed in a variety of ways. This is usually done by "keyhole" surgery, which involves a number of tiny cuts in the stomach and right side of the chest, as well as a cut in the neck. If keyhole surgery is not possible, two larger cuts may be made, one down the center of your stomach and the other on your chest or above the collarbone. Some people require all three cuts. Your surgeon will have discussed the surgical strategy that is most likely to be employed with you. The procedure might take anything from 5 to 8 hours.

During the operation, most of your oesophagus and a small part of your stomach will be removed, along with the lymph glands, and the remainder of the stomach is made into a tube. This tube is joined to the remainder of the oesophagus, either in the chest or high in the neck, through the neck wound 

The excised region will be sent away to be examined under a microscope. This helps determine if you will require additional therapy. The Consultant Surgeon will go through the specifics of your procedure with you. This is a significant operation. Occasionally, during a scheduled gullet procedure, your surgeon may discover that the condition is not suited for surgery, maybe because the cancer is too advanced or has migrated to other organs. If this occurs in your situation, additional options for therapy will be reviewed with you.

 

Pancreaticoduodenectomy (Whipple procedure)

A surgical team collaborates to ensure that you have a safe and effective procedure. Pancreatic surgeons, specialist surgical nurses, anesthesiologists and anesthetists — physicians and nurses experienced in administering medication that induces you to sleep during surgery — and others make up the team.

Depending on the complexity of the procedure and your overall health, more intravenous lines with various monitoring devices may be put after you have fallen asleep. A urinary catheter, which is put into your bladder, will be used. This is used to drain urine during and after surgery. It is usually taken out one or two days following surgery.

Depending on the technique employed and the intricacy of the operation, surgery can take from four to twelve hours. Whipple surgery is performed under general anesthetic, so you will be unconscious and unaware during the procedure.

To get access to your internal organs, the surgeon creates an incision in your abdomen. The size and placement of your incision are determined by your surgeon's technique and your specific condition. The head of the pancreas, the beginning of the small intestine (duodenum), the gallbladder, and the bile duct are all removed during a Whipple surgery.

In some cases, the Whipple treatment may additionally include the removal of a part of the stomach or nearby lymph nodes. Depending on your condition, several types of pancreatic surgeries may be done.

Your surgeon then reconnects the remaining parts of your pancreas, stomach and intestines to allow you to digest food normally.

 

Conclusion

Upper gastrointestinal (GI) surgery is performed to address disorders of the small bowel, gall bladder, liver, pancreas, or esophagus.

The upper gastrointestinal tract is susceptible to a number of diseases that may necessitate surgical treatment. Upper GI surgery can be performed as:

• Oesophagectomy is a surgical procedure used to treat esophageal tumours that includes removing all or part of the esophagus.
• Gastrectomy is a surgical procedure used to treat stomach tumors. The stomach and adjacent lymph nodes are removed completely or partially.
• Laparoscopic (keyhole) surgery is a type of minimally invasive surgery. This procedure can be used to remove stomach and esophageal tumors.