Laparoscopic Antireflux Operations Incl. Nissen Fundoplication
If a combination of lifestyle changes and drug therapy does not remedy reflux symptoms, a Nissen Fundoplication can be a very effective surgical procedure to correct reflux. This procedure involves wrapping the upper portion of the stomach around the base of the oesophagus to reinforce the strength of the lower oesophageal sphincter. Until recently, the procedure required a large abdominal incision. A hospital stay of 1-2 days was usually required, and the time to full recovery and return to work was measured in weeks.
A laparoscopic Nissen Fundoplication is a minimally invasive approach that involves specialized video equipment and instruments that allow a surgeon to perform the procedure through four tiny incisions, most of which are less than a half-centimetre in size. One advantage of this method is a brief hospitalization. Most of the time it will require an overnight stay. Other advantages include less pain (less of a need for pain medication), fewer and smaller scars, and a shorter recovery time.
Laparoscopic Nissen Fundoplication is a safe and effective treatment of GORD. However, in rare cases the laparoscopic approach is not possible because it becomes difficult to visualize or handle organs effectively. In such instances, the traditional incision may need to be made to safely complete the operation.
This surgery is performed under general anaesthesia.
Laparoscopic Hernia Repair
The standard method of hernia repair involves making an incision in the abdominal wall. Normal healthy tissues are cut until the area of weakness is found. This area, the hernia, is then repaired with sutures. Often a prosthetic material, or another plastic material, is sutured in place to strengthen the area of weakness. Finally, the skin and other healthy tissues that were cut at the beginning are sutured back together to complete the repair.
Newer hernia repair involves minimally invasive laparoscopic techniques. However, hernia operation with open techniques is still a valid option reaching the highest standards of care. Laparoscopic techniques of hernia repair are especially attractive when patients are dealing with recurrent hernias or bilateral inguinal hernias.
Upper GI Cancer Surgery
What is Cancer?
Cancer is a disease that results from abnormal growth and division of cells that make up the body's tissues and organs. Under normal circumstances, cells reproduce in an orderly fashion to replace old cells, maintain tissue health and repair injuries.
However, when growth control is lost and cells divide too much and too fast, a cellular mass -or "tumour" -is formed.
If the tumour is confined to a few cell layers and it does not invade surrounding tissues or organs, it is considered benign. By contrast, if the tumour spreads to surrounding tissues or organs, it is considered malignant, or cancerous. In order to grow further, a cancer develops its own blood vessels and this process is called angiogenesis. When it first develops, a malignant tumour may be confined to its original site.
If cancerous cells are not treated they may break away from the original tumour, travel, and grow within other body parts, the process is known as metastasis.
Cancer Screening is the performance of tests on apparently well people in order to detect a medical condition at an earlier stage.
Oesophageal cancer (also called cancer of the oesophagus) is a malignant tumour that grows in the lining of the oesophagus. The oesophagus (the gullet) is the tube that carries food from the mouth down into the stomach using a series of muscular movements.
Types of Oesophageal Cancer
Two types of cancer, squamous cell carcinoma and adenocarcinoma, make up 90 per cent of all oesophageal cancers. Oesophageal cancer can occur in any section of the oesophagus. Most cancers in the top part of the oesophagus are squamous cell cancers. They are called this because the cells lining the top part of the oesophagus are squamous cells. Squamous means scaly.
Most cancers at the end of the oesophagus that joins the stomach are adenocarcinomas. Adenocarcinomas are often found in people who have a condition called Barrett's.
Laparoscopic Gall Bladder removal (Cholecystectomy)
What are the Benefits?
The main benefit of this procedure is that it is minimally invasive surgery. Minimally invasive surgery means "Lesser Pain" and "Faster Recovery".
There is no incision pain as occurs with standard abdominal surgery. So the recovery time is much quicker. Also, there is no scar on the abdomen.
Is laparoscopy always advised?
There are very few instances when laparoscopic surgery is not preferable to conventional surgery for cholecystectomy. This is especially true when the surgical
If an attack hasn't settled after 12 hours
If there are complications such as jaundice, pancreatitis
If patient suffers recurrent pain or vomiting
If patient suffers cholangitis
and nursing team is well experienced in the procedures and post-operative care.
The only real contraindication is if the anaesthetic risk is too high. Other, lesser contraindications - such as during the first trimester of pregnancy - need not pose a problem to the experienced laparoscopic surgeon.
Risks & Complications
Like any abdominal surgery, Laparoscopic Cholecystectomy carries some risks. Even though infrequent, it still carries the same risks as general surgery. Current medical reports indicate that the low complication rate is about the same for this procedure as for standard gallbladder surgery.
Complications are rare and may include:
Obesity - there are fewer post-operative complications with laparoscopic surgery
Previous surgery - adhesions can be dealt with successfully
Common bile duct stones can be removed by laparoscopy, or by ERCP
Severe cholecystitis is best dealt with acutely - one operation and recovery period - and can be done safely with laparoscopic technique
The disposable instruments - used are more expensive but carry no risk of hepatitis or AIDS. There are hidden costs to using non-disposable instruments, in cleaning and handling.
Surgical skill speeds procedures and lessens time-related theatre and anaesthetic charges.
Fewer complications occur, a saving because they add to the expense, requiring more time off work, more medications and more time in hospital.
Routine use of x-ray adds costs to theatre time, also to equipment, radiographer, radiologists and chemicals.
An experienced laparoscopic nursing team - when staff are familiar with the equipment and procedures there will not be problems of inappropriate or unnecessary use of antibiotics or catheters.
Bleeding & infection may occur but is rare with experienced surgeons
In a few cases, the gallbladder cannot be safely removed by laparoscopy. Standard open abdominal surgery is then immediately performed
Nausea and vomiting may occur after the surgery
Injury to the bile ducts, blood vessels, or intestine can occur, requiring corrective surgery
Bile Duct Exploration
What is common bile duct (CBD) exploration?
The CBD is a tube connecting the liver, gallbladder, and pancreas to the small intestine that helps deliver fluid to aid in digestion.
The CBD exploration is a procedure used to see if a stone or some obstruction is blocking the flow of bile from your liver and gallbladder to your intestine.
When is it used?
If a stone or obstruction is blocking the CBD, bile can back up into the liver causing jaundice. Jaundice is when the skin and white of the eyes become yellow.
The CBD might become infected and require emergency surgery if the stone or blockage is not removed. This procedure can be done during the removal of the gall bladder.
An alternative would be an ERCP (Endoscopic retrograde cholangiopancreatogram) or not having treatment. You should discuss these options with your doctor.
Preparation for CBD exploration
During the procedure
Eat light the day before
Have nothing to eat or drink after midnight
Take only medicines as instructed the morning of surgery
Post operation instructions
You will be required to stay in the hospital for one to four days. You will also be asked to avoid strenuous activity for four to six days, and will require a follow-up visit with your doctor.
Benefits of CBD exploration
The surgery should alleviate your discomfort and will decrease the chance of infection and jaundice.
As with any surgery there are risks, although minimal:
General anesthesia relaxes your muscles and puts you into a deep sleep, so you will feel no pain.
The doctor will make a small incision in the abdomen, locate the CBD, and inject a dye into the duct. Your doctor will then take an X-ray, which will show where the stone or obstruction is located.
If stones are found, the doctor will make a cut into the duct and remove them.
A tube might be inserted into the duct and out the skin to drain bile into a bag.
The bag will remain in place anywhere from seven days to many weeks.
The doctor might repeat the dye procedure before removing your tube.
Immediately call your doctor if you have any of the following symptoms:
Complications of general anesthesia
Swelling or scarring of the duct
Increased abdominal pain
Soreness, redness, warmth, or drainage around the wound
Nausea and vomiting
Upper G I Endoscopy
Alt Names: Gastroscopy
Upper GI endoscopy is a procedure performed by a doctor, a well-trained subspecialist who uses the endoscope to diagnose and, in some cases, treat problems of the upper digestive system.
The endoscope is a long, thin, flexible tube with a tiny video camera and light on the end.
By adjusting the various controls on the endoscope, the doctor can safely guide the instrument to carefully examine the inside lining of the upper digestive system.
Click on the button above to launch an interactive web based presentation on endoscopy.
Diagnostic Indications for Endoscopy
Difficulty in Swallowing
Persistent isolated nausea or vomiting. In the event of isolated nausea or vomiting persisting for more than 2 days, investigation of the upper gastrointestinal tract is justified after any nongastrointestinal origin and acute intestinal occlusion have been eliminated
Digestive disorders. Upper gastrointestinal endoscopy is recommended in:
Subjects aged over 45 years and/or if there are any warning signs or symptom's such as anaemia, difficulty swallowing, weight loss or any other warning signs and symptoms
Subjects aged under 45 years with no warning signs or symptoms, upper gastrointestinal endoscopy is recommended in the following situations
Positive diagnostic test for Helicobacter pylori
When symptomatic treatment has failed or recurrence occurs at the end of treatment
Chronic anaemia and/or iron deficiency anaemia. Upper gastrointestinal endoscopy is recommended in iron-deficiency anaemia and/or iron deficiency, after any non-gastrointestinal origin has been eliminated
Acute gastrointestinal bleeding originating in the upper gastrointestinal tract. Upper gastrointestinal endoscopy is recommended as first choice in acute digestive bleeding which is assumed to originate in the upper gastrointestinal tract (haematemesis or melaena)
Gastro Esophageal reflux (GERD). Upper gastrointestinal endoscopy is recommended if there are symptoms of gastrooesophageal reflux combined with warning signs (weight loss, dysphagia, bleeding, anaemia), or if the patient is aged over 50 years, or if there is a recurrence on withdrawal of treatment or resistance to medical treatment