Functional Upper Abdominal Surgery

Upper gastrointestinal surgery (UGI) is probably the most recent specialization within surgery internationally.

The esophagus and stomach form a coherent system in terms of anatomy, function, oncology, and (almost exclusively minimally invasive) surgical techniques.

Expertise in this field has been built up over decades, ranging from functional diagnostics with antireflux surgery and bariatric surgery to complex oncological minimally invasive double-cavity procedures (esophageal resection with sleeve gastrectomy), so that even transhiatal extended gastrectomies with D2 lymphadenectomy and double-tract reconstruction can be performed minimally invasively.

The considerations of functional diagnostics are complemented by an understanding of nutrition and oncology, so that over the years a working group consisting of four specialists has been established for this demanding field. This working group is interdisciplinary and regularly collaborates with the tumor board as well as nutritional medicine, metabolic medicine, and psychology in order to optimally fulfill its tasks in the best interests of patients.

Findings necessary in order to establish an indication

The following documents and findings are desirable for the initial consultation at the specialist outpatient clinic for functional upper abdominal complaints:

• Referral from a specialist or general practitioner with a clear question
• Medical history: (previous operations, list of medications)
• Gastroscopy with biopsies (duodenum, antrum, corpus, Z-line, and esophagus) and description of the situation (hernia, inflammation, mucosal condition) according to current standards
• Functional diagnostics (if available, please also provide raw data)

Patient information

Functional upper abdominal surgery

Functional complaints in the upper abdomen are a common problem that encompasses a variety of symptoms such as pain, pressure, bloating, and discomfort in the upper abdominal area. These complaints often occur without any identifiable structural or organic cause and can affect various functions of the gastrointestinal tract.

The exact causes of functional upper abdominal discomfort are not always clear, but factors such as stress, unhealthy nutrition, and disturbed intestinal flora may play a role.

The treatment of functional upper abdominal discomfort often focuses on alleviating symptoms and improving the patient’s quality of life. This includes lifestyle changes such as healthy food, stress management, and regular physical activity. The use of medication and the possibilities of surgical symptom control are examined in detail and can have a positive long-term impact on quality of life.

Since functional complaints in the upper abdomen are often complex and individual, a thorough medical examination and, if necessary, collaboration with various specialists is required to develop the best possible treatment strategy for each patient.

Gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is a common condition characterized by the reflux of stomach acid into the esophagus. Typical symptoms include heartburn, acid reflux, difficulty swallowing, or coughing. In cases where drug therapies are insufficient (voluminous reflux is hardly affected by medication) or are not tolerated, surgical treatment is recommended.

Surgical treatment of GERD aims to restore the reflux barrier, which consists of the lower esophageal muscle, the angle between the esophagus and stomach, and the diaphragmatic crura. A commonly used technique is fundoplication, in which this barrier is created by forming a cuff around the distal esophagus. This procedure is performed laparoscopically or with a surgical robot as standard.

Surgical treatment of GERD offers long-term benefits and can reduce the need for lifelong medication. Nevertheless, the risks and benefits of any surgery should be discussed individually with a doctor.
Link to: https://link.springer.com/article/10.1007/s41971-021-00119-4

Difficulty swallowing and achalasia

Difficulty swallowing can have a wide variety of causes. A thorough examination and functional diagnostics (manometry, various types of motility testing, imaging) are essential diagnostic cornerstones in differentiating the symptoms. Treatment is tailored to the individual cause of the difficulty swallowing and includes lifestyle modifications, drug therapies, endoscopic therapies, and surgery. Achalasia is a special form of swallowing disorder.

Achalasia is a rare disease of the esophagus characterized by impaired function of the lower esophageal sphincter, leading to swallowing difficulties, regurgitation of food, and chest pain. Achalasia is caused by an inflammatory process that damages the nerve cells in the esophagus, leading to a loss of swallowing function. Unfortunately, achalasia cannot be cured, but the associated symptoms and the loss of swallowing function can be improved.

Endoscopic and surgical treatment of achalasia aims to reduce pressure in the lower esophageal sphincter and facilitate the passage of food into the stomach. A commonly used procedure is Heller myotomy, in which the lower esophageal sphincter is surgically severed to facilitate the passage of food. This operation is performed laparoscopically or with a surgical robot as standard. In addition to myotomy, fundoplication is performed at the same time to reduce the risk of reflux esophagitis.

Endoscopic procedures include stretching the esophageal sphincter, Botox injection, or endoscopic division of the lower sphincter (POEM). We do not currently offer POEM.