Common surgical procedures of the gastrointestinal tract

CHAPTER 21 Common surgical procedures of the gastrointestinal tract

Upper gastrointestinal procedures

Cancer surgery

The principle of cancer surgery is to remove the tumor completely with histologically proven margins and the lymph nodes that drain the tumor. Histologically, completeness of tumor clearance from the resection margins is classified R0, R1and R2. An R0 resection is defined as one where all margins are histologically free of tumor. An R1 resection is defined as one in which microscopic residual disease has been left behind. An R2 resection is defined as incomplete resection with macroscopic residual disease.

Benign surgery

Antireflux procedures

Indication: Gastro-esophageal reflux disease including repair of hiatus hernia.

Procedure: Performed laparoscopically, this procedure essentially consists of two parts:

Antireflux surgery has a number of variations; however, the two gold standard procedures were described by the German surgeon Rudolph Nissen (1896–1981) and the French surgeon Andre Toupet born in 1915. Nissen’s fundoplication is a complete (360 degrees) wrap with the fundus round the lower esophagus and Toupet’s fundoplication is one where the fundus wraps the posterior aspect of the lower esophagus, variations suggest between 180 and 270 degrees (Figures 21.4 A–F).

Main blood vessel divided: the short gastric vessels may be divided.

Postoperative barium appearance: the lower esophagus is slightly narrowed by the wrap and the esophagus may have a bird’s beak appearance. Barium often has a slight delay before passing into the stomach.

Dec 26, 2015 | Posted by in GASTROINTESTINAL IMAGING | Comments Off on Common surgical procedures of the gastrointestinal tract
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