Gastrointestinal Surgery

Gastrointestinal Surgery is a surgical specialty that deals with disorders and diseases of the digestive system, including surgical interventions on organs like the esophagus, stomach, small and large intestines, rectum, liver, gallbladder, pancreas, and rarely the spleen. GI surgery is conducted for a variety of conditions, which may range from cancers and blockages to inflammatory diseases and other disorders hampering the normal functions of the digestive organs. The surgeries range from minimally invasive techniques like laparoscopic surgery to big open surgeries based on the severity and location of the condition. GI surgery plays a paramount role in the management of complex diseases of the gastrointestinal tract, greatly improving patient outcomes.

What Are the Common GI Conditions That Require Gastrointestinal Surgery?

Here are some of the disorders that require Gastrointestinal Surgery:

• Gastroesophageal Reflux Disease (GERD)
• Peptic Ulcer Disease
• Gallstones and Gallbladder Disease
• Appendicitis
• Diverticulitis
• Crohn's Disease
• Ulcerative Colitis
• Colorectal Cancer
• Hiatal Hernia
• Pancreatitis
• Hernias
• Bowel Obstruction
• Obesity

What Are The Types Of Gastrointestinal Surgery?

(GI) surgery encompasses a wide range of procedures that target different parts of the digestive system. Below is a list of the various types of GI surgeries:

1. Appendectomy: An appendectomy is a surgical procedure that falls under gastrointestinal surgery amongst many other procedures. An appendectomy refers to the surgical removal of the appendix, which is found in the right lower side of the abdomen. This procedure is generally carried out on an emergency basis to treat appendicitis (inflamed appendix). Appendicitis has some common symptoms which include nausea, vomiting, constipation, loss of appetite, and pain. Sometimes, these symptoms may be missing and it becomes essential to consult an expert to evaluate the abdominal cavity to make a diagnosis.
2. Hemorrhoidectomy: Hemorrhoids or piles refer to swollen veins in and around the anus and in the lower rectum. Piles can be classified into: Internal piles and External piles. Internal piles as the name suggests evolve inside the rectum and are not visible from the inside. On the other hand, external piles develop on the outside of the anal opening and are quite visible. Hemorrhoidectomy or piles surgery is a surgical procedure conducted by healthcare experts to remove hemorrhoids. Surgery is important to treat hemorrhoids since it can cause several bothersome symptoms like itching, pain, bleeding, and lumps around the anus.
3. Bariatric Surgery: Bariatric surgery or weight loss surgery is a surgical procedure performed on individuals who are severely obese. This surgery is typically recommended to individuals who attempted other weight loss methods and were unsuccessful and have critical health problems. Bariatric surgery aims to reduce the size of the stomach to restrict the quantity of food the person eats or absorbs.
4. Cholecystectomy: A cholecystectomy is a surgical procedure done to remove the gallbladder (a pear-shaped organ that is located below the liver on the upper right side of the abdomen). The function of the gallbladder is to collect and store a digestive fluid produced in the liver called bile. A cholecystectomy is majorly performed to treat gallstones and the complications they cause. Gallstones refer to the hardened deposits of digestive fluid that can develop in the gallbladder. The size of a gallstone can be a grain of sand to as large as a ball.
5. Esophageal Surgery: Esophageal surgeries treat conditions that affect the esophagus, which may include cancer, very bad acid reflux, or structural problems. These include esophagectomy, where part or all of the esophagus is removed, usually due to cancer; fundoplication, which strengthens the valve between the esophagus and the stomach to prevent acid reflux; and in cases of blockages, the diameter of the esophagus needs to be increased by dilation or a stent is placed. Esophagogastrostomy is also performed by connecting the remaining esophagus to the stomach when its part gets removed.
6. Stomach Surgery: Stomach surgery includes all types of operations to fight diseases like cancer, ulcers, or obesity. Gastrectomy is the procedure to remove a part of or the entire stomach, with the most likely cause being cancer or severe ulcers. Reducing the size of the stomach and rerouting the small intestine is a widely used weight-loss procedure in the form of gastric bypass surgery. Gastric sleeve surgery is a type of bariatric surgery that involves the partial removal of the stomach to form a thin tube. Pyloroplasty is the surgical widening of the opening of the lower part of the stomach into the small intestine.
7. Liver Surgery: Liver surgery is primarily performed to treat liver cancer, tumors, or other liver diseases. Hepatectomy involves the removal of a portion of the liver, often due to cancer. In cases of severe liver disease, liver transplantation may be required, where the diseased liver is replaced with a healthy donor liver. Liver resection refers to the surgical removal of a portion of the liver affected by disease or tumors, with the remaining liver regenerating over time.
8. Endoscopic Surgery: Endoscopic surgery involves minimally invasive procedures that are done using an endoscope to treat or diagnose conditions within the GI tract. EMR stands for endoscopic mucosal resection, which removes precancerous or cancerous tissue from the lining of the digestive tract. ESD stands for endoscopic submucosal dissection and denotes the removal of deeper layers; this is usually reserved for larger and more invasive tumors. These procedures are less invasive compared with traditional surgeries and many times have quicker recovery times.

What Tests Are Performed Before Gastrointestinal Surgery?

The tests may include:

• Blood Tests: Overall health and surgical preparedness can be gauged with blood tests. A CBC (Complete Blood Count) will check anemia, infection, and overall condition of the blood, while a BMP (Basic Metabolic Panel) or CMP (Comprehensive Metabolic Panel) will enlighten one about the kidney and liver functions, electrolyte levels, and blood sugar. A Coagulation Profile will also be required to assess the blood clotting mechanism to avoid excess blood loss during the surgery.
• Imaging studies: Imaging tests are very important for the diagnosis and surgical planning of a patient. X-rays primarily outline major abnormalities or problems in the GI tract. When a detailed, clear view is required, CT scans, also known as Computed Tomography, show slices of the abdomen and pelvis that identify tumors, inflammation, and/or structural problems. MRI utilizes highly detailed soft tissue images, particularly in complicated scenarios. Ultrasound deals with sound waves and is used to visualize organs and most conditions such as gallstones and abnormalities of the liver.
• Endoscopy: Endoscopy is a technique of visualization of the GI tract through a soft tube with a camera at its end. Gastroscopy is used to examine the esophagus, stomach, and duodenum for conditions like ulcers or tumors, while a Colonoscopy deals particularly with the colon and rectum, enabling an overall look at the lining and optionally providing biopsy and removal of polyps of suspicious areas.
• Electrocardiogram: An electrocardiogram records the electrical activity of the heart, assessing pre-existing heart conditions. This is particularly important in determining whether the patient can undergo surgery and anesthesia safely, bearing in mind the abnormalities of the heart that might lead to dire consequences during the surgery process.
• Pulmonary Function Tests: These tests are conducted to measure the volume and performance of the lungs, which becomes crucial in the evaluation of a patient's tolerance for anesthesia and physical stresses that come with surgery, especially if one has a history of some sort of respiratory condition.
• Barium Swallow or Enema tests: They involve giving the patient a barium solution to trace areas of the GI tract on an X-ray image. In this test, the patient will swallow the barium, allowing for visualization of the esophagus, stomach, and duodenum in order to diagnose swallowing problems and structural defects. A Barium Enema involves the insertion of barium into the rectum for the visualization of the colon and rectum. It aids in the detection of tumors or diverticula and other abnormalities.

What Happens During a Gastrointestinal Surgical Operation?

Following is a step-by-step explanation of what happens during gastrointestinal surgery:

1. Preoperative Preparation: The preparation for gastrointestinal surgery starts with an extensive medical check-up, imaging, and endoscopy where necessary to view the passage of food. An anaesthesiologist goes through the anesthesia plan with the patient. The patient is then asked to starve in order to minimize surgical complications. If the colon and rectum are involved, bowel preparation may be necessary. The surgeon then describes the procedure after which the patient consents by signing a form.
2. Anesthesia and Incision: The next step in the process will involve the administration of anesthesia on the day of surgery, followed by positioning on the operation table. Sterilization of the site of operation is done next, followed by making an incision: large in open surgery and small in minimally invasive surgery.
3. Surgical Procedure: Surgery, after the initial incision, involves meticulous dissection through skin, fat, muscle, and connective tissue in order to reach the gastrointestinal tract. Care should be done without causing injury to the surrounding structures, which may involve blood vessels, nerves, or other organs. Once the abdomen is opened, an exploratory survey may be done whereby all the organs are palpated and looked at with eyes by the surgeon to make sure that everything has been seen properly for the condition in question.
   The type of surgical intervention will depend on the problem diagnosed. If resection is necessary, your healthcare provider will remove that part of the GI tract, such as a segment of the colon in malignancy or serious disease. In benign conditions, such as polyps or ulcers, it is sufficient to excise the abnormal tissue. In the case of hernias, the weakened area is repaired, usually with mesh to add some strength to the tissue.
   Bypass is necessary when the operating surgeon creates a new path for the passage of the digestive contents by diverting around a diseased portion of the tract. In a few very serious cases, as in an advanced liver disease, a transplantation may be performed wherein a diseased organ is replaced with a healthy donor organ.
4. Closing the Incision: Once the procedure is completed, the physician will then check if there is not too much bleeding. The doctor then closes the incision using sutures or staples. Sterile dressings are applied to the site to protect and ensure healing.

What Are The Advantages Of Gastrointestinal Surgery?

Here are the advantages of gastrointestinal (GI) surgery:

1. Effective Treatment of Serious Conditions: The surgery is a sure cure for serious conditions such as cancer, serious infections, or even a structural abnormality that medication may not cure.
2. Relieving of Symptoms: Cures symptoms like pain, nausea, blockages, and digestive problems, which enhance the quality of life in general.
3. Enhanced Functionality: It restores normal functionality to the digestive system, after which patients usually regain the ability to go back to normal food intake and digestion.
4. Minimally Invasive Options: Technology advancement has encouraged minimal invasiveness, such as laparoscopic surgery, which reduces recovery time, lessens pain, and minimizes the chances of complications.
5. Enhanced Recovery Time: Faster recovery and lesser hospitalization, as against traditional open surgeries, ensure that one can get back to normal routine activities faster.
6. Weight Loss and Management: Sophisticated bariatric surgeries like gastric bypass and sleeve gastrectomy have been working like magic for long-term weight loss and management of a certain obesity-related condition in an individual.
7. Prevention of Complications: Surgical intervention may obviate or minimize serious complications from an untreated condition, such as perforation or sepsis.
8. Improved Quality of Life: A very large number of patients report immense improvement in quality of life, improved digestion with fewer symptoms, and general well-being.

How To Prepare For A Gastrointestinal Procedure?

Preparing for a gastrointestinal (GI) procedure involves several necessary steps to ensure the best possible outcome. Here's a guide on how to prepare:

• See Your Surgeon or Gastroenterologist: Speak with your doctor regarding the procedure, detailing what will take place, what sort of risks could occur, and what kind of preparation should be done beforehand. Provide your doctor with your entire history of medical ailments and the medications you are taking to make sure it is safe and can be tailored to suit your needs.
• Pre-procedure Instructions: Follow all dietary and medication adjustment instructions given by your doctor. This may mean you need to fast or take a special diet to prepare your digestive system for the procedure.
• Plan for Transportation: Since you might be sedated or anesthetized, you will require someone to drive you home after the procedure, to ensure utmost safety and comfort.
• Plan recovery: Make sure you have time off to rest and have support in place if you need it. The recovery may differ depending on the procedure you're going to have. You may wish to line up help with daily activities like grocery shopping and household chores and devise a comfortable recovery area.
• Follow Hygiene and Preparation Guidelines: If required for your procedure, take laxatives or use an enema as instructed to prepare the bowel. Also, follow other personal hygiene instructions, such as using antibacterial soap, to properly prepare yourself.
• Smoking and Drinking: Avoid smoking and drinking alcohol as much as possible during the days before your procedure, as this will, to some extent, hinder healing and the proper functioning of anesthetics.
• Confirm Details: Make sure that you confirm the time and place of your procedure with your provider in order to ensure everything goes according to plan.

What Are The Recovery Tips To Follow After The Gastrointestinal Surgical Procedure?

Here are some of the essential recovery tips one needs to follow after a GI surgical procedure:

• Follow Medical Instructions: Follow post-operative instructions outlined by your surgeon or healthcare team. This includes taking prescribed medications, managing wound care, following dietary restrictions, and activity limitations.
• Manage Pain and Discomfort: Take pain medications as directed to minimize discomfort. You may take over-the-counter pain relievers, but only if your doctor has advised you to do so. Apply topical ointments recommended or follow some strategy to manage your pain.
• Fluid Intake and Dietary Restrictions: Progress from clear liquids to solid foods according to what you are told by your doctor. Keep yourself hydrated by drinking lots of fluids. Further, follow dietary restrictions, if any, against the occurrence of complications and to promote healthy recovery.
• Rest and Avoid Strenuous Activities: Rest is a part of recovery. Accordingly, take adequate rest, avoid heavy lifting, bending forward, and vigorous exercise with the advice from your doctor. You can advance the level of activity after consulting your doctor.
• Watch for Complications: Be aware of signs of complications such as increased pain, fever, swelling, and abnormal discharge at the operated area. Contact the health provider if you experience worrying symptoms.
• Follow-up Appointments: Attend all the follow-up appointments with your healthcare provider. Such doctor visits allow close monitoring of recovery, making it possible to resolve many issues. These appointments also ensure adequate healing and make it possible for any necessary adjustments to your care plan.
• Take Good Care of Your Wounds: Always keep your incisions or the surgical site clean and dry. Follow the directions provided by your healthcare provider and do away with touching or scratching the incision area since it increases the chance of getting an infection.
• Gradually Return to Your Regular Activities: Return to your routine gradually. Follow your doctor's recommendations about when to resume work, exercise, or daily activities.
• Promote Digestive Health: Add gentle, easy-to-digest foods to your diet while you're recovering. Probiotics or fiber supplements, if advised by your doctor, can also aid digestion.
• Emotional Support: Surgery and recovery can be an emotional time. You can also reach out for support from family, friends, or a counselor if you need extra help with stress or anxiety during this recovery period.