Stomach, pancreas, esophagus, liver & bile

Operations with bening and malignant diseases

Reflux disease is a widespread disease. Most common symptom is heartburn, caused by running up ("reflux") of acid gastric juice into the esophagus. Usually the disease can be treated medically, but in some cases, the reflux is so strong that acid blockers are no longer sufficient, because mostly at night the stomach content "runs up" into the mouth and thus can not only disturb the sleep but also reach the lungs. Such aspirations can be life-threatening. The cause is a diaphragmatic hernia, which makes the "valve" at the transition from the esophagus to the stomach ineffective. The operation is done laparoscopically. The "up-slid" stomach part is again placed into the abdominal cavity and the gap in the diaphragm is sewn up so that only the esophagus passes through it. Depending on the findings, the seam is reinforced on the diaphragm by more seams between the stomach and the diaphragm, or a cuff from the stomach wall is sewn around the esophagus.

Moreover, the diverticula of the esophagus ("bulging") and benign tumors that did not enter the stomach can be operated minimally invasive in the same way. Diverticula of the esophagus in the neck region ("Zenker diverticulum") always lead to swallowing disorders and high aspiration. They can also be eliminated with aged people by a small intervention at the neck.

Today gastric and duodenal ulcers are operated only if they cause complications. Frequently occur perforations of such ulcers. In this case it is necessary to perform an emergency operation ("acute abdomen"). Usually it is sufficient just to sew the hole again, we do this laparoscopically. Hemorrhages from ulcers can almost always be controlled using gastroscopy, but sometimes an operation is necessary to stop the bleeding. In such cases a partial resection of the stomach usually takes place, as for example, in the case of the scarred narrowing of the pylorus.

More and more tumors occur of the deeper layers of the stomach wall. These can usually be removed laparoscopically by means of restricted resection, thus it is not necessary to remove the entire stomach, as with stomach cancer, which is fortunately becoming increasingly rare. In malignant tumors of the esophagus and in tumors that grow from the stomach into the esophagus, access though the right thoracic cavity is often necessary, but the lower parts of the esophagus can also be reached from the abdominal cavity. Our clinic is one of the few hospitals that regularly fulfills the prescribed minimum amount of oesophageal surgery! (To reduce the risk one needs experience, this is what this regulation is for).

The fear to become unable to eat after the removal of the stomach or parts of the esophagus is groundless. Our nutrition counseling helps the patient in the transitional period. Big advances in surgery and anesthesia technology make it possible to perform large tumor operations safer and with lower complication rates. A chemotherapy partly with irradiation before the operation, improves the chances of permanent healing in many cases.

Removal of the gall bladder due to stones or inflammation is one of the most common operations. The procedure is almost always performed laparoscopically, even after previous operations. In certain patients, we perform the laparoscopic surgery with a single incision on the navel of about 2 cm long. (Single port laparoscopy = SILS).

The bile fluid is formed in the liver, and flows even after the removal of the gall-bladder through the main gallal duct into the duodenum. A diet is not necessary after he removal of the gall bladder!

Jaundice that occurs as the result of the bile flow disorder ("obstruction") can be caused by stones or tumors. Clarification by an endoscopic ultrasound examination or a bile duct mirroring ("ERCP") is often necessary, stones can then also be removed from the bile duct during the same operation. In case of tumors further investigations are necessary, and here we work closely with our colleagues in internal medicine!

Often a tumor of the pancreas causes a bile duct closure, because the last section of the bile duct runs through the pancreas. In such cases the "Whipple's operation" is often indicated. During this serious intervention parts of the pancreas, duodenum, gall bladder, parts of the bile duct and rarely parts of the stomach are removed. Then the reconstruction takes place by sewing the pancreas residue, the bile duct and the stomach to the small intestine. In the field of pancreas operations we, too, are one of the few hospitals which reach the prescribed minimum quantities and can therefore carry out these operations at all.

In case pancreatitis an operation can also be necessary, during the “acute pancreatitis” the necrotic parts of the pancreas are sometimes removed, in case of chronic pancreatitis a bile duct occlusion can develop as a result of scarring, and a surgery should be performed in order to eliminate the chronic pain. In pancreatitis cases organ preserving techniques stand in the foreground, in order to avoid postoperative diabetes (insulin is formed in the pancreas!).

Tumors of the liver are often metastases of other tumors, but there are also primary liver tumors. Often, liver tumors removals have good prospects for healing. For large metastases, a large liver part often has to be removed, which is possible because the liver has big reserves and regenerates rapidly. Smaller foci, especially on the margins, benign tumors, cysts, etc. are removed laparoscopically.