Gastric Surgery | Specialists and Information

The stomach can be affected by various diseases. 

The most common conditions are tumors and inflammatory diseases, such as:

• stomach ulcers
• inflammation of the stomach lining (gastritis)
• irritable stomach and
• gastroesophageal reflux disease (heartburn)

Heartburn refers to a burning pain in the stomach area that can radiate from the sternum up to the throat and pharynx @ staras /AdobeStock

Only a very small number of inflammatory conditions require surgical treatment. However, gastritis can develop into a stomach ulcer (peptic ulcer disease) over time.

This results in damage to the stomach lining. If left untreated, the lesions in the lining can extend through the stomach wall outward into the abdominal cavity.

Medication for peptic ulcer disease or lifestyle changes are not always successful.

Surgery may be appropriate in the following cases:

• The patient still experiences symptoms despite treatment
• The stomach ulcer does not heal
• Complications such as bleeding occur
• There is suspicion of a malignant tumor

Gastric carcinoma (stomach cancer) is a very serious disease that almost always requires surgery. The diagnosis and treatment of gastric carcinoma should be conducted promptly and in a multidisciplinary manner.

Other stomach tumors, such as GIST (gastrointestinal stromal tumor), generally also require surgical removal.

In the Western world, reflux disease is also common. It is usually accompanied by heartburn. Doctors can usually treat it with medication. In certain cases, however, surgical treatment is advisable.

Stomach ulcers and stomach tumors are the most common stomach conditions treated surgically @ New Africa /AdobeStock

Other diseases or conditions that experts in gastric surgery frequently treat (or help treat) include:

• Gastric lymphomas (also a type of cancer)
• Benign tumors (leiomyomas, etc.)
• Stenoses (narrowing at the stomach outlet or entrance)
• Injuries to the stomach (e.g., caused by foreign objects, chemical burns, or physical trauma)
• Congenital anomalies (such as pyloric stenosis in infants)
• Stomach torsion (volvulus)
• Diaphragmatic hernia (hiatal hernia: the displacement of parts of the stomach through the diaphragm into the chest cavity)

For people who are morbidly obese, gastric surgery specialists may perform gastric reduction surgery or create a gastric bypass following appropriate evaluation.

These procedures result in significant weight loss. This also involves changes in lifestyle and dietary habits.

One of the most important procedures for examining stomach complaints is gastroscopy (stomach endoscopy).

Using a gastroscope, which doctors insert through the mouth into the stomach, they can examine the stomach lining.

This allows them to detect inflammation, ulcers, and tumors and to take tissue samples (biopsy). They can also use this method to perform minor therapeutic procedures (such as the removal of small tumors).

In the laboratory, experts examine the tissue samples for tumor cells or bacteria, such as Helicobacter pylori, a bacterium that can cause stomach ulcers and, ultimately, stomach cancer.

During a gastroscopy, doctors examine the esophagus, the stomach, and part of the duodenum using a thin, flexible tube (gastroscope) @ Kzenon /AdobeStock

Doctors can easily detect narrowings and hernias (diaphragmatic hernias) using a contrast-enhanced X-ray examination.

Other imaging techniques are used in tumor diagnostics, such as:

• Ultrasound (sonography)
• Computed tomography (CT), 
• Combined CT-positron emission tomography (PET), and
• Magnetic resonance imaging (MRI) 

Using laparoscopy, doctors can reliably examine the abdominal cavity, the stomach from the outside, and other organs or structures. If necessary, they can perform initial therapeutic procedures right away.

Depending on the condition, various treatment methods may be considered. 

Doctors distinguish between endoscopic and surgical procedures. In addition to its diagnostic significance, gastroscopy also plays an important therapeutic role.

For example, it can be used to:

• Remove foreign bodies and small tumors
• Use a laser to treat strictures, or
• Stop bleeding by inserting special clips, adhesives, or medications

Most surgical procedures today are minimally invasive, that is, laparoscopic. However, total gastrectomy for gastric cancer is still performed as open surgery in most centers. 

The minimally invasive surgical technique using laparoscopy is gentler on the patient and allows for a faster recovery.

The following conditions can now be treated laparoscopically:

• Repair of diaphragmatic hernias (hiatal hernia surgery)
• Perforated gastric ulcers
• Tumor removal
• Anti-reflux sleeves for the treatment of reflux disease (anti-reflux surgery, reflux surgery)
• Partial gastrectomy for tumors or morbid obesity
• Gastric bypass or gastric banding for the treatment of morbid obesity (adiposity)

In gastric bypass surgery, doctors divide the stomach. They connect the remaining small portion of the stomach to the small intestine, which has also been divided. This allows the food bolus to enter the small intestine directly.

Experts in gastric surgery are typically visceral surgeons. They have completed specialized training in visceral surgery.

They are therefore specialists in all surgical procedures involving the following structures:

• Abdominal cavity
• Abdominal wall
• Abdominal glands
• Soft tissues
• Tumors (cancer)
• In special cases, also for transplants

They determine whether treatment should be surgical or conservative. They are also proficient in all endoscopic, laparoscopic, minimally invasive, and open surgical procedures.

Specialists in internal medicine and gastroenterology (gastrointestinal specialists) are also experts in matters related to gastric surgery.

However, they do not perform surgeries. They are the patients’ first point of contact when it comes to undergoing gastroscopies and other diagnostic procedures.