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GASTROINTESTINAL SURGERY includes the intestinal tract from the Esophagus (the food tube) which enters the stomach and this is continuous with 22 feet of small intestine which is also continuous with 6-8 feet of large intestine (the colon). The colon empties into the rectum and waste exits via the anus. Diseases may occur along the entire extent of the Gastrointestinal tract.
A.) ESOPHAGUS: Irritation from acid called reflux (gastro-esophageal reflux disease or GERD) is very common and is almost always treated medically without operation. If there is also an esophageal hernia (in the region where the esophagus penetrates the diaphragm to enter the stomach) then frequently the symptoms are too difficult to treat medically and therefore a surgical repair of the "hernia" is necessary. This may be able to be performed open (incision) or by Laparoscopic methods. The surgery is very successful in over 90-95% of patients, but is usually reserved for those failing medical treatments or those with complications of GERD.
B.) STOMACH: This is the "mixing bowl" for food and is the center for acid production. It is the acid which produces ulcers, along with a bacteria called H.Pylori. Most frequently, gastritis and ulceration are treated medically but occasionally operations are needed for medical failures resulting in bleeding, perforation, blockage and other unrelenting symptoms. This is usually performed in the open (incision) fashion and is highly successful.
C.) SMALL INTESTINE: Surgery is usually required for inflammatory diseases, polyps or tumors. The small intestine is also frequently "blocked" due to hernia entrapment or adhesions (scar tissue) from prior operations requiring direct operation.
D.) LARGE INTESTINE (COLON): Many disorders attack the colon from inflammation, diverticulitis, polyps and tumor formations. The inflammations are usually treated with medicines and antibiotics unless complications occur including blockage (obstruction); bleeding, abcess formation or perforation then surgery is the best treatment. This is usually done open and may or may not require a colostomy bag depending on the findings.
Polyps in the colon are usually removed by colonoscopy, but if larger or malignant (cancer) then surgery is needed. Usually a colostomy bag is not required unless the mass is very large or very low in position (near the anus).
E.) ANUS, RECTUM: Polyps or cancers occur in the rectum and frequently require surgery and the likelihood of a colostomy bag is significant given the location of the tumor. In the anus, the major disorder is hemorrhoids (or piles). These are simple varicose veins in the anal region. These are usually treated medically unless this is no longer effective, the patient’s symptoms too great or uncontrollable - then surgery is recommended. The surgery entails removing and tying the hemorrhoids. The postoperative discomfort is considerable, but controllable and thereafter requires careful attention to diet and stool habits.
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