Gastric Surgery | Specialists and Information

The stomach, which consists mainly of muscle and glandular cells, is an important part of the digestive tract into which the oesophagus opens. The stomach merges directly into the duodenum.

It serves as a reservoir for the food pulp and mixes it with stomach acid. The stomach pre-digests food components and kills bacteria.

For this purpose, the glandular cells produce substances such as the enzyme pepsinogen and hydrochloric acid. These break down the proteins and break them down into their individual components in the further course of digestion.

The body can then absorb these. On the other hand, gastric glands also release mucin, a substance that protects the stomach lining from the aggressive hydrochloric acid.

What diseases do gastric surgery specialists treat?

The stomach can be affected by various diseases.

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

• peptic ulcer
• inflammation of the gastric mucosa(gastritis, gastritis)
• irritable stomach syndrome and
• reflux disease (heartburn)

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

Only very few inflammatory diseases require surgical treatment. However, gastritis/gastritis can develop into a peptic ulcer over time.

This results in damage to the stomach lining. If no treatment is given, the mucosal defects can extend outwards through the stomach wall into the abdominal cavity.

Drug therapy for peptic ulcer disease or a change in lifestyle is not always successful.

Surgery may be advisable in the following cases:

• The patient is not symptom-free despite therapy
• The peptic ulcer does not regress
• Complications such as bleeding occur
• There is a suspicion that the ulcer is malignant

Gastric carcinoma (stomach cancer) is a very serious disease that practically always requires surgery. Diagnosis and treatment of gastric carcinoma should be carried out quickly and on an interdisciplinary basis.

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

Reflux disease is also common in the western world. It is usually accompanied by heartburn. Doctors can usually treat it with medication. In selected cases, however, surgical treatment is advisable.

Stomach ulcers and tumors of the stomach are the most common diseases of the stomach to be treated surgically @ New Africa /AdobeStock

Other diseases or changes that gastric surgery experts often (co-)treat are

• Gastric lymphomas (also a type of cancer)
• Benign tumors (leiomyoma, etc.)
• Stenoses (constrictions in the area of the stomach outlet or inlet)
• Injuries to the stomach (e.g. caused by foreign bodies, chemical burns, violence)
• Malformations (for example pyloric stenosis in infancy)
• Twisting of the stomach (volvulus)
• Diaphragmatic hernia (hiatal hernia: the displacement of parts of the stomach through the diaphragm into the chest cavity)

In the case of morbidly obese people, gastric surgery specialists can perform a stomach reduction or gastric bypass after appropriate clarification.

These procedures lead to significant weight loss. This also includes a change in lifestyle and dietary habits.

What diagnostic procedures do gastric surgery specialists use?

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

Using the gastroscope, which doctors insert into the stomach via the mouth, they can assess the stomach lining.

Inflammations, ulcers and tumors can be detected and tissue samples can be taken (biopsy). They can also use this method to carry out minor therapeutic procedures (such as the removal of small tumors).

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

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

Doctors can easily detectconstrictions and hernias (diaphragmatic hernias) using a contrast medium X-ray examination.

Other imaging procedures are used in the field of tumor diagnostics, such as

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

With the help of laparoscopy, doctors can reliably examine the abdominal cavity, the stomach from the outside and other organs and structures. If necessary, they can also carry out initial therapeutic interventions.

Which treatment methods are included in the range of services offered by a gastric surgeon?

Depending on the disease, various treatment methods are possible.

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

It can be used, for example, to

• Remove foreign bodies and small tumors
• Remove constrictions using a laser or
• Stop bleeding by inserting special clips, adhesives or medication

Most surgical procedures today are minimally invasive, i.e. laparoscopic. However, the complete removal of the stomach for gastric carcinoma is still performed openly in most centers.

The minimally invasive surgical technique using laparoscopy is gentler and allows the patient to recover more quickly.

The following diseases can now be treated laparoscopically:

• Repair of diaphragmatic hernias (hiatal hernia surgery)
• ruptured stomach ulcers
• Removal of tumors
• Sleeves for the treatment of reflux disease(anti-reflux surgery, reflux surgery)
• Removal of parts of the stomach for tumors or morbid obesity
• Gastric bypass or gastric banding for the treatment of morbid obesity (adiposity)

In gastric bypass, doctors cut through the stomach. They then connect the small remaining stomach to the small intestine, which is also severed. This allows food to pass directly into the small intestine.

What distinguishes specialists in gastric surgery?

Experts in gastric surgery are usually visceral surgeons. They have completed specialist training in visceral surgery.

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

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

They assess 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 (stomach and intestinal specialists) are also experts in questions relating to stomach surgery.

However, they do not perform operations. They are the first point of contact for patients when it comes to gastroscopies and other investigations.