Upper Gastro Intestinal Surgery
Upper gastrointestinal surgery is surgery of the lower oesophagus, the stomach or the small intestines.
Three major areas's in this surgery are:
Tumors of the stomach
Gastrointestinal Erosive Reflux Disease (GERD) or 'acid reflux'
Achalasia: this is a narrowing of the lower esophagus with obstruction of food and liquids
Tumors of the stomach
These can be benign, low grade malignant or fully malignant.
Surgery of the stomach is done in many variants .
Oncologic (cancer) cases are treated multidisciplinary and discussed preoperatively and postoperatively with the different involved departments such as the department of oncology.
If possible the surgery is done minimally invasive, keeping safety, oncologic reasoning and feasibility (e.g. the size of the tumor) as guidelines. The procedure involves possible neo-adjuvant treatment with chemotherapy agents by the oncologist, taking out the tumor and reconstructing stomach and intestines to have a normal function afterwards.
Depending of the location of the tumor, the whole stomach needs to be resected and a reconstruction done or a partial gastrectomy can be done, leaving part of the stomach in.
Classification Surgery: Major
Anesthesia: General (Full intubation and sedation)
Minimal invasive laparoscopic procedure: Yes
Expected hospital stay: Short stay (2 days) hospitalisation or longer
Complications and measures
All surgery under general or regional anesthesia carries systemic risks such as deep venous thrombosis, lungembolus, cardiovascular complications: These risks are minimised through preoperative screening procedures and prophylactic (preventing) measures (anticoagulation agents, antibiotics on indication)
Specific complications due to this surgery:
-Anastomotic or stapler leak (low chance, less than 10%)
-Postoperative bleeding( low chance, less than 10%)
-Wound infection (low chance, less than 10%)
Total Gastrectomy
Partial Gastrectomy
GERD
Acid reflux is a modern day disease affecting many. It is multifactoral but and can largely be treated by anti-acid agents in a variety of forms nowadays.
In certain cases however, GERD is therapy resistant for conservative treatment with agents.
The lower esophageal valve can be so disfunctional that acid from the stomach will keep coming up into the esophagus, not only causing discomfort but also damaging the tissue, damage that can lead to (pre)cancerous lesions.
In these cases a surgical reconstruction of the LES can be achieved through surgery.
The surgery always involves a correction of the diaphragmatic hernia and a pivoting reconstruction (fundoplication) of the upper stomach to enhance LES function by creating an internal neo-valve.
Thera are different reconstructions possible varying in the matter the pivoting is done (e.g.Toupet, Nissen)
The operation is done minimal invasively (laparoscopic) with a fast patient recovery and short hospital stay.
Classification Surgery: Major
Anesthesia: General (Full intubation and sedation)
Minimal invasive laparoscopic procedure: Yes
Expected hospital stay: Short stay (2 days) hospitalisation or longer
Complications and measures
All surgery under general or regional anesthesia carries systemic risks such as deep venous thrombosis, lungembolus, cardiovascular complications: These risks are minimised through preoperative screening procedures and prophylactic(preventing) measures (anticoagulation agents, antibiotics on indication)
Specific complications due to this surgery:
-Anastomotic or stapler leak (low chance, less than 10%)
-Postoperative bleeding( low chance, less than 10%)
-Wound infection (low chance, less than 10%)
These are anonymous patient video's of actual operations performed by an AAH staff surgeon
They are used for illustration and educational purposes with patient consent.
Achalasia
Achalasia is muscular deformation/disfunctioning of the lower esophagus. The incidence is 1:100.000
The ethiology (medical cause) is relatively unknown but there is thought to be a auto-immune or infection factor involved. The affliction can be very discomforting with subtotal or near total blocking of food and beverage to the stomach.
Treatment options vary from infiltration with agents to endoscopic pneumodilatation with a high recurrence rate often
ending with surgery as a definite result.
The operation involves releasing the thickened and encaging tissue and freeing the innerside of the esophagus opening up the passage and making a small plicating reconstruction with the upper stomach (Heller-Dor procedure)
The procedure is done minimally invasive (laparoscopically) with short stay hospitalization.
Classification Surgery: Major
Anesthesia: General (Full intubation and sedation)
Minimal invasive laparoscopic procedure: Yes
Expected hospital stay: Short stay (2 days) hospitalization or longer
Complications and measures
All surgery under general or regional anesthesia carries systemic risks such as deep venous thrombosis, lungembolus, cardiovascular complications: These risks are minimised through preoperative screening procedures and prophylactic(preventing) measures (anticoagulation agents, antibiotics on indication)
Specific complications due to this surgery:
-Anastomotic or stapler leak (low chance, less than 10%)
-Postoperative bleeding(low chance, less than 10%)
-Wound infection (low chance, less than 10%)
These are anonymous patient video's of actual operations performed
They are used for illustration and educational purposes with patient consent
