Appendectomy is the most common surgical digestive (abdominal) intervention.
Emergency appendectomy is carried out in young patients. Presentation of acute appendicitis is often quite atypical and may be suggestive of gastroenteritis, urinary tract infection or, in women, a gynaecological problem. Most often, the seat of the pain is between the umbilicus and the right iliac crest.
The blood test is an important diagnostic element, but is sometimes normal. There is generally inflammation (elevated C-reactive protein ) and infection (increase in white blood cells). Ultrasound and scan are only valuable if positive.
After a straightforward appendicitis, the patient recovers in 2 to 3 days. With peritonitis, the problem may be much more complex and your stay in hospital is likely to be for one week.
Colon surgery is necessary for malignant diseases (colon cancer) or for benign diseases (diverticulosis sigmoid). The principle of this surgery is to remove a segment of colon and restore continuity (sew the two ends together). In the event of failure or impossibility of connecting the remaining colon, the surgeon may be compelled to perform a colostomy (stoma or "bag").
- Right colectomy: this consists of the removal of the right half of the colon. It can be performed in the conventional way or via laparoscopy. The risks during the operation are accidental lesion of the duodenum or right ureter, and after the operation, suture dehiscence.
- Left colectomy: this time it concerns removing the left half of the colon. The laparoscopic technique is more often used here than for the right colectomy. The risks of this operation, during the operation, are impairment of the spleen or left ureter, and afterwards, just as for the right colectomy, suture dehiscence.
- Sigmoidectomy: removal of the portion of the colon located between the left colon and rectum. Most often performed via laparoscopy and sometimes via a single-port.
- Hartmann: this is a type of emergency operation performed in the event of severe peritonitis. In this case, the local situation (peritonitis) does not allow the suture to be created between the two colonic ends. The creation of a bag is required (stoma). This "digestive mutilation" is usually temporary. Restoration of digestive continuity can be envisaged more or less long term.
- Colostomy closure: this term includes several very different situations. Straightforward colostomy closure consists of closing a side port on the colon, which had been provisionally created to divert materials. In this case, the procedure takes place via a topical route and lasts less than an hour. If it is a matter of restoring continuity after a Hartmann procedure, the surgery is much more complex. The colonic circuit is interrupted, and a segment is missing which must be replaced with another. This major surgery takes a minimum of 2 hours 30 minutes.
Gastric surgery especially concerns obesity surgery, but there are also stomach cancers that require the undertaking of either a partial gastrectomy, if the tumour is at an early stage, or total gastrectomy, if the lesion is advanced.
- Partial gastrectomy: this concerns the removal of the distal portion of the stomach (also called the "gastric atrum"). This procedure is offered for small tumours in the lower part of the stomach. To restore digestive continuity, the rest of the stomach is connected directly to the small intestine. Postoperative digestive comfort is generally preserved (almost normal diet).
- Total gastrectomy: in this case, the surgeon removes the whole stomach with the surrounding nodes. It is necessary to perform this operation if there is a large tumour in the main part of the stomach. Digestive continuity is then restored by "connecting" (the medical term is "anastomosing") the end of the oesophagus to the small intestine. Digestive comfort is often altered. To maintain the correct nutritional state, the patient should split meals and take nutritional supplements.
The gall bladder is often the seat of the formation of stones. These "stones" are composed of cholesterol crystals, which can block the bladder and trigger intense pain in the upper abdomen that lasts several hours, and vomiting. If these symptoms are neglected, it may result in cholecystitis, that is, acute inflammation then infection of the bladder, this time with permanent pain, fever and impairment of the general state of the patient. Emergency surgery is then more difficult and complicated.
- Cholecystectomy: an operation to remove the gall bladder. It is usually performed via laparoscopy, although conversion to the open route is possible in rare cases. A single-port procedure is often possible.
-Bile duct stone: this problem results from a stone passing from the gall bladder into the choledochal canal. The surgical treatment for this disease consists of removing the stone either through the cystic duct (through which the stone has passed), or by opening the choledochal canal and performing a cholecystectomy during the same anaesthesia. The situation may be made more complex by an infection of the bile duct (acute cholangitis) or by the anatomy of the bile duct. If the situation is not favourable for surgery, the gastroenterologist will extract the stone(s) naturally (endoscopy) under anaesthesia, and cholecystectomy is performed at a later stage.
- Biliodigestive anastomosis: if the choledochal canal is blocked by numerous stones or tumorous obstacle in the bile duct without the possibility of the removal of the tumour, the surgeon can set up a connection between the choledochal canal and intestine to drain the bile. There are several types of biliodigestive anastomosis. One of the simplest is choledocoduodenal anastomosis. One of the most classic is the choledocojejunal anastomosis in Roux-en-Y. The choice is guided by the type of disease and the topical conditions.
The abdominal wall has areas of weakness, which over time may evolve and result in the formation of hernias whose contents can become "strangled. Abdominal wall surgery has been revolutionised by laparoscopy. Many of the following interventions are performed through small holes, which minimise abdomen aggression. These procedures require the establishment of parietal prostheses that reinforce the wall by interposing themselves between the "push" (the inside of the stomach) and the support plane (the abdominal muscles).
- Inguinal hernia: the most common. It occurs in men and follows the path of the spermatic cord. It can be treated with open surgery or via laparoscopy..
- Umbilical hernia: in the case of umbilical hernia, the hernia sits on the umbilicus. Untreated, the hernia increases in volume and becomes painful, reflecting local inflammation. It can be treated with open surgery or via laparoscopy.
- Incisional or ventral hernia: sometimes, areas of weakness are triggered by previous surgical procedures. Scars are "fragile" areas for years after surgery. In the event of postoperative incisional or ventral hernia, it is advisable to repair the stomach not only for aesthetic reasons but also in order to restore the abdominal strap, which has a key respiratory role. It can be treated with open surgery or via laparoscopy..
- Abdominoplasty: this procedure is frequently performed in the aftermath of major weight loss. It involves the removal of excess skin and fatty tissue from the lower abdomen. This procedure is delicate and sometimes fraught with complications.
Disease of the small intestine is dominated by problems of scar tissue and adhesions. This phenomenon frequently occurs after abdomen surgery. These fibrous adhesions are internal scars which form between various different organs and cause constriction of the intestine and occlusion. Scar tissue occurrence is unpredictable. Any abdominal operation may cause the formation of scar tissue, even a straightforward old appendectomy. Tumours (rare) and diverticula are equally possible and may lead to the resection of a portion of the intestine.
- Section of scar tissue: in the event of occlusion on scar tissue, an emergency procedure should be carried out. The scar tissue has the effect of blocking the arrival of blood in the tissues, which then develops into necrosis (or devitalisation). However, if the occlusion is removed quickly, recovery is rapid.
- Small resection: the surgeon is forced to remove a segment of the intestine. To connect the two ends, he creates an anastomosis (or "suture"). Recovery is longer.
- Hiatus hernia: like any hernia, hiatus hernia is a hole (opening) in a wall. Unlike other hernias, it is not visible because it involves the wall between the abdomen and thorax. The opening is located at an area of weakness, which is the point where the œsophagus crosses the diaphragm known as the œsophageal hiatus – hence the term hiatus hernia. In some cases, the hiatus hernia is responsible, in addition to symptoms of problematic reflux, a chronic cough or respiratory failure. In these relatively rare cases, the preoperative assessment will be completed with an evaluation of the respiratory function by a pulmonologist. The surgical procedure consists of reducing the hernia (returning the stomach to the abdomen) and shrinking the hole (bringing the diaphragm pillars closer together) and at the same time allowing the œsophagus to comfortably pass through it. Laparoscopic (minimally invasive) surgery is feasible for hiatus hernia.
- Oesophagectomy: the surgery involves removing the œsophagus and replacing it with the stomach (most common situation) or connecting the remaining œsophagus to the stomach. Surgical interventions on the œsophagus are responsible for feeding difficulties and/or malnutrition. Oesophageal surgery is usually performed because of early-stage cancer. Despite therapeutic advances, this cancer is associated with poor prognosis in terms of survival. Prolonged survival is still possible with surgical resection combined with a good "response" to concomitant treatments (radiotherapy and chemotherapy). The patient's nutritional state is crucial in this disease. Indeed, over 70% of these patients are malnourished. Preoperative treatment will include an estimation of the nutritional state of the future operated individual, and, wherever possible, additional calorie intake. Postoperatively, feeding will be temporarily ensured by means of a jejunostomy tube.
Anatomically, these two organs are in close proximity.
The pancreas, which secretes insulin, is a deep-seated organ in contact with the aorta and the vena cava.
The spleen, which has an immune role, is located at the tail of the pancreas in contact with the stomach.
- Cephalic duodenopancreatectomy: CPD (Cephalic duodenopancreatectomy) is a long and delicate procedure. Generally, it takes three to five hours. The main risk is haemorrhage. It is carried out for tumours of the pancreas head.
- Left splenopancreatectomy: this procedure is more straightforward than the previous one. It consists of removing the spleen and tail of the pancreas.
- Splenectomy: this involves complete removal of the spleen.
Terminal portion of the digestive tube
- Cure for rectal prolapse: rectal prolapse is the externalisation of the rectum through the anus. This rectal disease is more common than you might think and addresses two very distinct populations. It concerns either insufficient anchoring of the rectum, which may affect young men, or weakening in the anchoring and support of the rectum through dehiscence of the pelvic floor and sphincter mechanism, which is more common in women. Repairing this disease, which threatens faecal continence, is based on the principle of anchoring the rectum to bone at a fixed point – the promontory. This technique is hence known as promontofixation.
- Anterior resection of the rectum: so called because it requires an anterior abdominal incision. The procedure consists of removing the pathological rectal portion. It involves lesions in the upper third rectum (located between 10 and 15 cm from the anus). In cases of malignant disease (cancer of the rectum), resection will be wide so as to remove the entire tumour with the maximum number of nodes and safety margins (distance between the tumour and the area of the surgical section) of 5 cm. The creation of a stoma (artificial anus) may be recommended in some cases. Clarification will be given if this is the case. It is generally a protective ileostomy. Transit is diverted to allow better healing of the intestines.
- Colorectal anastomosis: this technique should be used for cancers in the middle third of the rectum. It enables the sphincter function to be retained. All perirectal nodes are removed en bloc (mesorectum).
- Abdominoperineal resection: less performed because of the increasingly large choice of options for retaining the sphincter while providing adequate resection quality from an oncological point of view. In this case, sacrifice of the sphincter function is inevitable. The tumour invades or is very close to the sphincter mechanism. This intervention involves permanent colostomy, meaning the creation of a stoma (bag). The surgical technique involves two stages. The "upper third" stage consists of mobilising the colon and rectum, then severing the colon and performing a colostomy on the left. The "lower third" stage consists of removal of the sphincter and lower third rectum and closing the perineum.