GASTROENTEROLOGIC SURGERY RISKS RESULTS
Category: General Surgery
Abstract : Advances in laparoscopy allow the direct study of large portions of the liver, gallbladder, spleen, lining of the stomach, and pelvic organs. Many biopsies of these organs can be performed by laparoscopy. Increasingly, laparoscopic surgery is replacing open abdomen surgery for many diseases, with some procedures performed on an outpatient basis. Gastrointestinal applications have resulted in start
Advances in laparoscopy allow the direct study of large portions of the liver, gallbladder, spleen, lining of the stomach, and pelvic organs. Many biopsies of these organs can be performed by laparoscopy. Increasingly, laparoscopic surgery is replacing open abdomen surgery for many diseases, with some procedures performed on an outpatient basis.
Gastrointestinal applications have resulted in startling changes in surgeries for appendectomy, gallbladder, and adenocarcinoma of the esophagus, the fastest increasing cancer in North America.
Significant other diseases include liver, colon, stomach, and pancreatic cancers; ulcerative conditions in the stomach and colon; and inflammations and/or irritations of the stomach, liver, bowel, and pancreas that cannot be treated with medications or other therapies. Recent research has shown that laparoscopy is useful in detecting small (< 0.8 in [< 2 cm]) cancers not seen by imaging techniques and can be used to stage pancreatic or esophageal cancers, averting surgical removal of the organ wall in a high percentage of cases. There are also recent indications, however, that some laparoscopic procedures may not have the long-lasting efficacy of open surgeries and may involve more complications.
This drawback has proven true for laparoscopic fundoplication for GERD disease.Advances in gastrointestinal fiber-optic endoscopic technology have made endoscopy mandatory for gastrointestinal diagnosis, therapy, and surgery. Especially promising is the use of endoscopic techniques in the diagnosis and treatment of bowel diseases, colonoscopy, and sigmoidoscopy, particularly with acute and chronic bleeding. Combined with laparoscopic techniques, endoscopy has substantially reduced the need for open surgical techniques for the management of bleeding. For most gasteroenterologic surgeries, whether laparoscopic or open, preoperative medications are given as well as general anesthesia. Food and drink are not allowed after midnight before the surgery the next morning.
Surgery proceeds with the patient under general anesthetics for open surgery and local or regional anesthetics for laparoscopic surgery. Specific diseases require specific procedures, with resection and repair of abdomen, colon and intestines, liver, and pancreas considered more serious than other organs. The level of complication of the procedure dictates whether laparoscopic procedures may be used.
Diagnosis/Preparation
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.
Aftercare
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.
Risks
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 Crohns 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.
Morbidity and mortality rates
According to a recent study published by the British Journal of Surgery, a small minority of patients undergoing gastroenterologic surgery are at high risk for postoperative complications that may lead to prolonged hospital stays. In a study of 235 patients, 47% had at least one postoperative complication, with the length of hospital stay at 11 days compared to those without complications with length of stay at six days.
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