DR BAIPALLI RAMESH
Surgical Gastroentrologist
M.S. (Gen. Surg), PDCC (Surgical Gastroenterology), FICS, FAIS, FIAGES, FMAS, FALS.
Consultant Surgical Gastroenterologist, Bariatric (Obesity) Surgeon & Advanced Laparoscopic Surgeon at Lancet Laparoscopy Centre – Visakhapatnam.

GASTROINTESTINAL SURGERY

What is gastrointestinal surgery?

Gastrointestinal surgery is a treatment for diseases of the parts of the body involved in digestion. This includes the esophagus (ee-sof-uh-gus), stomach, small intestine, large intestine, and rectum. It also includes the liver, gallbladder, and pancreas.

Surgery may be used to remove a cancerous or noncancerous growth or damaged part of the body, such as the intestine. It may also be used to repair a problem like a hernia (a hole or weak spot in the wall of the abdomen). Minor surgical procedures are used to screen and diagnose problems of the digestive system.

Below are gastrointestinal conditions that may be treated with surgery:

  • Appendicitis. When the appendix becomes infected and inflamed, it may be removed (appendectomy).
  • Colon cancer and other gastrointestinal cancers. Surgery is done to remove cancerous tumors in the digestive system and parts of the digestive system that have cancer. For example, a surgeon may remove a tumor as well as part of the pancreas, liver, or intestine with cancer.
  • Diverticular disease. A diverticulum is a small pouch or pocket in the colon (large intestine). Researchers are not sure why these develop. Sometimes they can become inflamed and cause pain (diverticulitis). This is often managed without surgery. If someone has a lot of diverticula that often become inflamed, the doctor may recommend bowel resection surgery to remove that part of the intestine.
  • Gallbladder disease. When there is a problem with the gallbladder — usually gallstones — the gallbladder can be removed. Surgery to remove the gallbladder is also called a cholecystectomy (koh-luh-si-stek-tuh-mee).
  • Gastroesophageal reflux disease (GERD) and hiatal hernias. GERD, or acid reflux is when the acid from the stomach backs up into the esophagus (food pipe) and causes heartburn. Sometimes it happens because of a hiatal hernia. This is when the stomach pushes through the diaphragm, a muscle that separates the chest from the abdomen. A surgeon can do a surgery called fundoplication (fun-doh-pluh-cay-shun) to fix it. The surgeon will fix the hernia if there is one and then wrap the top of the stomach around the bottom of the esophagus to strengthen the sphincter, which keeps acid out.
  • Hernia. A hernia is when a part of the body (like the intestine) comes through a hole or weak spot in the wall of muscle or connective tissue that’s supposed to protect it (like the abdomen). It doesn’t come through the skin, but a bulge may be felt under the skin that’s not supposed to be there. It can also be painful. Gastrointestinal surgeons can repair the hole or weak spot.
  • Inflammatory bowel disease (Crohn’s disease and ulcerative colitis). With inflammatory bowel disease, the immune system attacks the intestines and causes pain and inflammation. This can lead to damage in the intestine. Sometimes the damaged parts are removed and the healthy parts are reconnected. This is called bowel resection.
  • Rectal prolapse. Surgery is used to treat rectal prolapse, a condition in which part of the intestine comes through the anus.
  • Weight loss. Different types of bariatric surgery (for example, gastric bypass) may be done to treat obesity. This surgery is usually done by a specialist in bariatric surgery.

A surgical procedure called an endoscopy is used to screen and diagnose problems of the digestive system. The doctor puts a long, thin tube with a tiny camera into the body to see inside. If the problem is with the stomach or esophagus, the doctor puts the scope through the esophagus. To check for colon cancer or other problems of the intestines, the doctor puts the scope through the anus into the intestine.

What are the risks and/or side effects?

Any surgery comes with some risks, including:

  • Infection. Anytime the body is opened up, infections can get in. Surgeons are very careful about keeping things sterile and clean during surgery, but there is always a chance of infection.
  • Pain. Depending on the surgery, there may be soreness and pain during recovery.
  • Bleeding and blood clots. Sometimes cuts from surgery continue to bleed, which can make recovery take longer. Sometimes the body forms a blood clot where the surgery was done, and the clot blocks an important blood vessel to the lungs, heart, or brain.
  • Damage to another body part. A healthy body part can be accidentally damaged during surgery.
  • Reaction to anesthesia. Some people don’t react well to anesthesia and may have nausea and vomiting.

What are the benefits?

Surgery to remove a tumor or diseased body part, or repair damage, can be lifesaving. Surgery can also improve the quality of life for someone who has not benefited from other treatments, like medicine or diet changes.

Colonoscopy is a minor surgical procedure with big benefits: it can catch colon cancer early enough to cure it. It’s important to get the recommended colon cancer screening.

How do I prepare?

Preparation for surgery depends on the type of surgery you have.

Follow Instructions
The doctor or nurse will tell you how to prepare for your surgery. Most likely, you will have instructions about not eating or drinking before the surgery. The doctor may also tell you to stop taking some of your medicines or vitamins before surgery. Follow all of the instructions you get for preparing for surgery.

Make a Plan for the Day of Surgery and After
Have a plan for who will take you to the surgery and who will take you home, even for a minor surgery.

Plan for who will help you in the days following your surgery. The week after you get home is the most important time after surgery. If all goes well, you’ll be on your way to a speedy recovery. If not, you may be making a return trip to the hospital.

Plan for any changes to your living space. Will you be able to climb stairs after your surgery? Will you be able to use the bathroom as is, or do you need a grip bar or other equipment? Do you have the food you need or a plan for someone to bring meals? If you need physical therapy after surgery, where will you do it?

How is it done or administered?

Most surgery is done by cutting into the body with a scalpel (a small knife) and other tools. Some surgery is done with a scope — a thin tube with a camera and small surgery tools — to remove growths in the colon, for example.

Surgery done by cutting into the body can be either open surgery or minimally invasive surgery.

  • Open surgery: The surgeon makes one large cut to open up the body.
  • Minimally invasive surgery, or laparoscopic (lap-er-uh-skop-ik) surgery: The surgeon makes a few small cuts and uses a camera to see inside the body. The surgeon inserts the camera in one cut and surgical instruments in other cuts. These smaller cuts usually heal faster than the large cut of open surgery.

Anesthesia (an-uhs-thee-zhuh) is used during the surgery to stop any feelings of pain. Local or regional anesthesia numbs only a certain part of the body while general anesthesia puts a person into a deep sleep. The type of anesthesia used depends on the surgery.

The surgery may be done in the hospital, an outpatient surgery center, or the doctor’s office or clinic. It depends on the kind of surgery and how complex it is.

When will I know the results?

The doctor will follow up with you to tell you how the surgery went and what you need to do next. The timing of follow-up depends on the type of surgery.

What are follow-up requirements and options?

Your doctor will talk with you about any follow-up treatment or care, and make a treatment plan for you.

What should I expect during recovery?

Recovery time will depend on the surgery and how invasive it was. With some simple surgeries, like a colonoscopy, you can get back to your daily activities right away. With more invasive surgeries, you may need some time to heal and some help with managing the pain after surgery. Be sure to ask your doctor about what to expect during recovery from your surgery.