Gastrointestinal Surgery

The digestive system is a continuous tract that runs from the esophagus through the stomach and duodenum, the small and large bowel, to the anus, supported by the liver, gallbladder and bile ducts and the pancreas. The benign and cancerous diseases of all these organs are treated medically by gastroenterology and surgically by gastrointestinal surgery, and the two work hand in hand. The field is usually grouped into upper gastrointestinal and esophageal surgery, colorectal surgery, hepato-pancreato-biliary surgery for the liver, bile ducts and pancreas, bariatric and metabolic surgery for severe obesity, and proctology for the anus and anal canal. A defining feature of modern practice is that, wherever it is suitable, these operations are performed by minimally invasive laparoscopic or robotic surgery, which can dramatically shorten recovery compared with traditional open surgery.

Upper gastrointestinal surgery treats reflux, hiatal hernia, achalasia and tumours of the esophagus and stomach. Colorectal surgery treats colon and rectal cancer and the inflammatory bowel diseases, Crohn's disease and ulcerative colitis, when a complication develops or medical treatment no longer controls them. Hepato-pancreato-biliary surgery covers gallstones and bile duct stones, gallbladder and bile duct disease, liver tumours and cysts including hydatid cyst, and tumours, cysts and inflammation of the pancreas. Bariatric and metabolic surgery offers operations such as sleeve gastrectomy and gastric bypass to treat severe obesity and related conditions. Proctology treats hemorrhoids, anal fissures and fistulas, pilonidal sinus and other conditions of the anus and anal canal. The field also repairs abdominal wall and incisional hernias and, where the spleen is diseased or injured, performs its removal.

Laparoscopic gallbladder removal is one of the most common operations and is usually a short, keyhole procedure with a quick recovery. Bowel cancer is treated by colectomy or anterior resection, removing the affected segment together with its lymph nodes, increasingly by laparoscopic or robotic methods. Reflux, hiatal hernia and achalasia that do not respond to medication can be corrected by advanced laparoscopic surgery that restores the valve mechanism between the esophagus and stomach. Stomach and esophageal cancers are removed surgically as part of a wider plan with oncology. Liver and pancreas surgery, among the most complex in the field, removes tumours and cysts while preserving as much healthy tissue and function as possible. Hemorrhoid, fissure and fistula surgery treats common anal conditions, while hernia repair and, when needed, removal of the spleen complete the picture. Many of these operations are supported by endoscopy, including diagnostic gastroscopy and colonoscopy and the placement of feeding tubes or stents.

Accurate diagnosis draws on the full resources of radiology, including ultrasound, computed tomography (CT) and magnetic resonance imaging (MR), and, for cancer, PET-CT to assess spread. Endoscopy is central: gastroscopy examines the esophagus and stomach, colonoscopy the large bowel, and both can take biopsies and treat some conditions directly. Interventional radiology adds image-guided biopsy, drainage and stent placement when these help. In the operating theatre, high definition laparoscopic cameras, robotic platforms and energy devices that seal and divide tissue precisely make complex minimally invasive surgery possible. Because digestive cancer is staged and treated by a team, the surgeon plans each case together with gastroenterology, medical and radiation oncology, radiology and pathology, so that surgery is one coordinated step in a complete treatment plan.

For people travelling from abroad, the journey usually begins remotely, with a review of your scans, endoscopy results and medical history so that a provisional plan and a realistic idea of the operation and recovery can be shared before you arrive. On arrival, an in person assessment and any remaining tests confirm the plan and your fitness for anaesthesia. A keyhole gallbladder operation may need only a day or two in hospital, while major bowel, liver or pancreas surgery needs several days to a week or more, with a more gradual recovery. Most patients are advised to stay in the destination area for one to a few weeks after discharge so wounds can be checked, bowel and digestive function can settle and fitness to fly can be confirmed. Interpreter and international patient services help with appointments, consent and day to day questions, and your team will set up remote follow up, with routine wound care often possible near your home, once you have travelled back.