What is Gastrointestinal surgery slideshare

General surgery
Lecture # 6
By:
Muhammad Sulaiman
KMU-IPMS
MS Health Care Management
MPH
CHPE
BS Surgical
Friday, December 22, 2023 Gastric Procedure 1

Gastrointestinal
Surgery

Considerations for Gastrointestinal
Surgery
 Separate instruments should be used for resection
and anastomosis.
 Two distinct setups may be used, but the single
setup is most commonly used.
 In single Setup For resection, anastomosis, and
abdominal closure contaminated instruments and
equipment from the field after use should be discard.

Surgery
 Gloves should be changed after anastomosis is
completed; gowns also may be changed.
 A nasogastric tube is often inserted for the aspiration of
gastric contents or for decompression of the intestinal
tract.
 A variety of gastrointestinal tubes should be available
for aspiration and irrigation.
 Normal saline solution, not sterile water, should be used
in abdominal procedures to moisten laparotomy
sponges.
 Normal saline is used for intraperitoneal irrigation
unless the surgeon prefers to use a solution such as
Ringer’s lactate.

Surgery
 ESUs are used routinely by many surgeons for electrocoagulation
of bleeding vessels in the abdominal wall, omentum, and
mesentery.
 Ligating clips or suture ligatures are used for large vessels.
 An intraluminal circular stapler can be used for end-to-end, end-
to-side, or side-to-side anastomoses from the esophagus to the
rectum.
 The technical principles that guide the surgeon for all
gastrointestinal anastomoses include:
• Good blood supply
• No tension
• Adequate lumen
• Watertight and leak proof
• No distal obstruction

Gastric Procedures
 Anatomy and Physiology of stomach ?????
 Indication of gastric surgical procedures??
 the presence of disease is established after laboratory
tests such as
 Gastric analysis,
 Gastroscopy,
 X-ray studies.
 Cancer
 Interference of gastric motor activity or muscular
contractions results in gastrointestinal complaints of
abdominal pain, nausea, vomiting, hemorrhage, and
dyspepsia.

Gastroscopy
 Passage of a flexible fiberoptic gastroscope.
 This procedure is usually performed while the
patient is sedated, with a topical anesthetic applied
in the oropharynx to control the gag reflex.
 We visually inspects the mucosal walls of the
stomach, and tissue specimens are sometimes
obtained.
 Bleeding points may be coagulated with a laser,
ESU, or a sclerosing agent

Gastrostomy
 Establishment of a temporary or permanent opening
in the stomach.
 Indicated for gastrointestinal decompression or to
provide alimentation for a prolonged period when
nutrition cannot be maintained by other means.
 A catheter is inserted percutaneously into the
stomach.

Simple gastrostomy.
 With the patient under general anesthesia, the
stomach is exposed through a small upper left
abdominal or midline incision.
 The catheter is inserted into the anterior gastric wall
and is held in place with sutures;
 it is brought out through a separate stab wound in
the left upper quadrant.
 The stomach is sutured to the abdominal wall at the
exit site of the catheter.

Percutaneous endoscopic
gastrostomy
 With percutaneous endoscopic gastrostomy, the patient is
placed under IV sedation.
 A fiberoptic gastroscope and insufflates the stomach with
air to create a working space and a turgid surface to the
stomach.
 Light from the scope is directed anteriorly for
transillumination through the abdominal wall.
 The surgeon infiltrates the skin with a local anesthetic at a
selected gastrostomy site, usually approximately one third
of the distance along the left costal margin at the mid-
clavicular line.
 The gastrostomy tube is introduced through a

Gastric Resections
 The stomach may be totally or partially resected for
removal of a malignant tumor or for benign
chronic ulcer disease.
 Circular staplers are commonly used for
anastomosis after resection.
 Leakage at the site of anastomosis leads to
peritonitis.

Total gastrectomy
 With a total gastrectomy, the entire stomach is excised
for malignant lesions through a bilateral subcostal,
long transrectus, or thoracoabdominal incision.
 A total gastrectomy necessitates reconstruction of
esophago-intestinal continuity by establishing an
anastomosis between a loop of jejunum and the
esophagus.
 This anastomosis may be end-to-side with a lateral
jejunojejunostomy or end-to-end with a Roux-en-Y
jejunojejunostomy.
 The purpose of the jejunojejunostomy is to prevent the
reflux of bile and pancreatic fluids into the esophagus.
 Some surgeons create a jejunal pouch for this purpose.

Total gastrectomy
 Roux-en-Y reconstruction involves the creation of a
jejunojejunostomy (forming a Y-shaped figure of
small bowel) downstream from the anastomosis of
the free jejunal end to the gastric remnant
(gastrojejunostomy).

Subtotal gastrectomy
 Partial resections of the stomach, originally
described by Theodor Billroth (1829-1894), are often
referred to as Billroth procedures.
 Indication for A benign lesion (usually an ulcer)
or a malignant lesion located in the pyloric half of
the stomach, In a patient with a gastric or duodenal
ulcer.
 A partial resection limits gastric acidity and relieves
pain, bleeding, vomiting, and weight loss.

Gastrojejunostomy or Billroth II
 Gastrojejunostomy is a surgical procedure in which
an anastomosis is created between the stomach
and the proximal loop of the jejunum.
 This is usually done either for the purpose of
draining the contents of the stomach or to provide a
bypass for the gastric contents.

Gastroduodenostomy, or Billroth I
 In a Billroth I surgery, only the antrum and pylorus
are removed and the stomach is attached to the
duodenum along its greater curvature

Gastroduodenostomy, or Billroth I
 In this procedure, the peritoneal cavity is entered
through a right paramedian or upper midline
abdominal incision.
 A variety of surgical procedures may be used to
reestablish gastrointestinal continuity.
 Anastomosis of the remaining portion of the
stomach to the duodenum.

Vagotomy
 Vagotomy is the surgical cutting of the vagus nerve to reduce acid
secretion in the stomach.
 The vagus nerve trunk splits into branches that go to different parts of the
stomach.
 Stimulation from these branches causes the stomach to produce acid.
 Too much stomach acid leads to ulcers that may eventually bleed and
create an emergency situation.
 A vagotomy is performed when acid production in the stomach can not be
reduced by other means.
 The purpose of the procedure is to disable the acid-producing capacity of
the stomach.
 It is used when ulcers in the stomach and duodenum do not respond to
medication and changes in diet.

Vagotomy
 The basic types of vagotomy are as follows:
 Truncal vagotomy (TV)
 Selective vagotomy (SV)
 Highly selective vagotomy (HSV)
 Vagotomy procedures, which are conservative
surgical therapies compared with gastrectomy,
decrease the surgical risk for select patients with
chronic ulcers.
 It is now known that ulcers caused by the
Helicobacter pylori organism can be cured with
antibiotics. Friday, December 22, 2023 Gastric Procedure 23

Bariatric Surgery
 Commonly referred to as weight loss surgery,
bariatric surgery is one of the few weight loss
treatments that has a history of proven results.
 The term bariatric surgery refers to any surgical
procedure on the stomach or intestines to induce
weight loss.
 Bariatric surgery can be performed as an open
abdominal surgery or as a five-trocar laparoscopic
procedure

Bariatric Surgery
 Bariatric surgery forces a reduction in calories or
minimizes the absorption of calories.
 Procedures that are restrictive in nature (your
stomach size is reduced) allow patients to feel full
after a small amount of food.
 This forces patients to eat less

Bariatric Surgery
 People who have a body mass index (BMI) of 40 or
more, weigh 100 pounds (45.4 kg) more than their ideal
weight, and who have failed to lose weight despite
years of medical treatment are potential candidates for
bariatric surgery.
 Patients with a BMI of 35 to 40 and have serious
comorbid disease, such as obstructive sleep apnea,
cardiomyopathy, and uncontrolled diabetes, may be
candidates after careful screening.
 A BMI between 18 and 25 indicates normal weight,
while a BMI between 25 and 30 indicates overweight
and a BMI above 30 is usually indicative of obesity.

Bariatric Surgery
 The physical size of a patient who is obese presents special
needs with respect to transporting and positioning, selecting
instrumentation, and providing psychologic and physiologic
support.
 Many morbidly obese patients have medical complications
such as hypertension, peripheral vascular disease, cardiac
disease, degenerative arthritis, gallbladder disease, or
diabetes mellitus.
 The plan of care for obese patients usually includes the
application of anti-embolic and the insertion of a nasogastric
tube, a Foley catheter, IV and arterial lines, and central
venous pressure (CVP).
 Because respiratory distress is a potential complication during
the induction of anesthesia, intubation while the patient is

Bariatric Surgery
 Bariatric procedures for gastric restriction are not
without risks. Nutritional deficiencies, anemia,
wound infection.
 Bariatric procedures produce three types of results:
 1. Restricted intake caused by an inflatable Silastic
band.
 2. Bypass the food and decrease absorption.
 3. Bypass absorption and restrict intake.

GASTRIC SLEEVE SURGERY
 Average Excess Weight
Loss: 57% to 70%
 Serious Complication
Rate: 0.96%
 Type of Procedure:
Restrictive
 Key Benefits
 Average of 60% to 70%
excess weight loss.
 May reduce hunger.
 No foreign objects like Lap
Bands.

GASTRIC BYPASS SURGERY
 Average Excess Weight
Loss: 60% to 80%
 Serious Complication
Rate: 1.25%
 Procedure Type: Restrictive and
Mal-apsorptive.
 Key Benefits:
 Long history of success and
clinical studies to validate its
effectiveness.
 Average of 60% to 80% excess
weight loss.
 May reduce hunger.
 May relieve heartburn and
acid reflux.

Adjustable Gastric Banding Surgery
 Laparoscopic
adjustable gastric banding is
surgery to make the stomach
smaller.
 It is done to help people
lose weight.
 The surgery limits the
amount of food the stomac.
 This helps you eat less and
feel full more quickly.

Bariatric Surgery
 Patients are advised not to eat concentrated sugars
because it stimulates dumping syndrome.
 Nutrient supplements, such as vitamins, iron, and
calcium, are necessary to prevent anemia and
osteoporosis.

Complications of Gastric surgery
 After gastric surgery, dumping syndrome may be
experienced by patients shortly after eating.
 This complication occurs when food and fluids
empty rapidly into the jejunum.
 It is characterized by nausea, vomiting, weakness,
dizziness, pallor, sweating, palpitations, and
diarrhea, and it may persist for 6 months to 1 year.

Note
For any type of query/question regarding these slides
please Email on:
 Msulaiman.ipms@kmu.edu.pk
 Muhammadsulaiman21@gmail.com

THANK YOU

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