Laparoscopic Colon Surgery

Laparoscopic Anti-reflux Surgery

Laparoscopic Gartric Surgery

Laparoscopic Small Bowel Surgery

Laparoscopic Liver Surgery

Laparoscopic Pancreatic Surgery

Laparoscopic Bariatric Surgery 

Laparoscopic Colon Surgery
Since the early 1990's, surgeons have been performing laparoscopic colon resections for a variety of reasons.  The three main reasons to have a colon resection are:

• diverticular disease
• unresectable polyps
• malignancy

Regardless of the reason for the colon resection, a laparoscopic colon surgery is usually performed through four or five small incisions with the largest incision being used to remove the specimen.  The patient undergoing laparoscopic colon surgery will experience less post-operative pain, a shorter stay in the hospital, less scaring, a quicker return to activities, and less wound complications.  Specific to colon surgery, patients having this surgery performed minimally invasively will also have less blood loss during the operation, less blood transfusions after the operation, and eat sooner after the operation than patients who have a standard open surgery.

It is well accepted by surgeons across the country to perform colon resections laparoscopically for diverticular disease or unresectable polyps; however, the mid 1990's saw a concern about performing laparoscopic colon resections for malignancy.  Today, there is enough Level I (considered the best) evidence from national and international studies that this year, at a variety of national conferences, laparoscopic surgery for colonic malignancies was considered to be safe and appropriate for patients with colon cancer.  In fact, there is early evidence that certain patients may actually live longer if they have their resection performed in a minimally invasive fashion.

Laparoscopic Anti-reflux Surgery

Since the late 1950's, surgeons have been performing surgery in an attempt to treat gastro esophageal reflux disease (GERD).  The surgery involved a "wrap" of the upper portion of the stomach around the last part of the esophagus to recreate the valve that prevents reflux, the "lower esophageal sphincter."  The surgery became more popular when a laparoscopic technique was available.  The laparoscopic technique accomplishes the same goals as open surgery, but through smaller incisions.  These results in a shorter stay in the hospital, less pain after the operation, a quicker return to normal activities, and less wound complications.

Today, anti-reflux surgery is appropriate for only about 10% of patients with reflux disease.  Specifically, those patients who cannot take strong anti-acid medications like Nexium or Protonix, those patients who find that their symptoms have returned despite increasing dosages of these medications, and those patients who have complications related to their reflux disease.  These complications may manifest themselves as a stricture, precancerous changes on endoscopically performed biopsies called dysplasia, or damage to other organs such as voice changes, adult onset asthma, chronic cough, or chronic sinusitis.  A very careful work-up is necessary for all patients under consideration for anti-reflux surgery.  In properly selected patients, the "cure" of their symptoms is approximately 95%.

Laparoscopic Gastric Surgery

The development of laparoscopic anti-reflux surgery taught surgeons that it was relatively easy to perform surgery on the stomach through small incisions.   Surgeons found that the visualization provided by the laparoscope was better than that of the naked eye.  They also recognized that it was exposure of structures high up under the rib cage (where the stomach sits) was easier through the small incisions and the use of long instruments.  With the advantages of laparoscopic surgery, namely the reduced hospital stay, the reduced pain, the quicker return to activities, and the reduced wound complications; it was a natural extension to attempt to perform complicated gastric procedures through the laparoscope.

Today, it is well accepted to perform surgery on the stomach through the laparoscope for perforated and bleeding ulcers, for benign stomach tumors, and to perform operations for morbid obesity.

Laparoscopic Small Bowel Surgery

There are a number of conditions that affect the small intestine that can be approached in a laparoscopic fashion.  These include small bowel perforation, incarcerated hernias, tumors, and inflammatory bowel disease.

Small bowel perforations can results from ingested foreign bodies or from congenital weaknesses called diverticula.  The resulting abscess can be drained laparoscopically and the resection of the involved segment of intestine can be performed in a laparoscopically assisted fashion.

Incarcerated hernias can results from weaknesses in the groin, called inguinal hernias or from weaknesses in prior incisions called incisional hernias.  When the weakness allows a portion of the intestine to bulge through and get "stuck," the patient often suffers severe pain, nausea, and vomiting.  An urgent operation may need to be performed to reduce the incarcerated segment of intestine.  Such operations can be performed through small incisions not only to reduce the trapped portion of intestine, but also to fix the hernia.  The repair of the hernia is achieved by using an absorbable or non-absorbable material called a "mesh" to "patch" the hernia or hole in the abdominal wall.

Laparoscopic Liver Surgery

The liver is not often thought of as an organ approached with the laparoscope, however, there are certain conditions that are amenable to a laparoscopic procedure.  These include drainage of cysts, biopsy of peripheral lesions, and ablation or resection of select tumors.  These procedures similarly benefit from all the advances of laparoscopic surgery including the improved visualization compared to open surgery, the shorter hospital stay, and the quicker return to activities after hospital discharge.

Laparoscopic Pancreatic Surgery

The last forefront of laparoscopic surgery is that of surgery on the pancreas.  The typical surgeon recites the mantra "Eat when you can, sleep when you can, go to the bathroom when you can, and DON'T MESS WITH THE PANCREAS."  It is a very unforgiving organ of the abdomen that is involved with our digestive process producing an array of enzymes and hormones necessary to digest and absorb nutrients properly.

The pancreas may present itself to the general surgeon in a variety of conditions including complications of pancreatitis, pseudocysts, chronic pancreatitis, or tumors.

The largest advance laparoscopically has been in the diagnosis and treatment of malignant tumors or the pancreas.  In a procedure known as a staging laparoscopy, the patient with a suspected malignant tumor of the pancreas undergoes a procedure through small incisions to see if the cancer has spread.  If so, the patient is saved the performance of a large, lengthy operation that has little hope for cure and can leave the hospital the following day.  The benefit comes in sparing the patient the pain of an open exploration and maintains the quality of life for the patient.

In essence, if you have a malignant tumor of the pancreas, your life expectancy is little over a year, but none of this important time left should be spent recovering from a painful open operation.  Even more impressive is that, depending on the location of the pancreatic tumor, certain resections can be performed through the small incisions.

Laparoscopic Bariatric Surgery

Morbid obesity has become a national health problem, with 16 million Americans that meet the criteria for being morbidly obese.  And the problem is growing.  We know now that the morbidly obese patient is a different class of patient, like the pregnant patient, the pediatric patient, or the elderly patient.  Their organs are different that the average adult.

They also have a number of medical conditions related to their obesity including: hypertension, cardiac disease, sleep apnea, elevated cholesterol, premature arthritis, infertility, diabetes, depression, and an increase risk for certain cancers.  Across the board, these patients have a higher risk of complications from any surgical procedure.

Last year, there were 300,000 obesity related deaths in the US alone.

For those patients that have failed all non-surgical attempts at weight loss, surgery becomes an excellent alternative.  While radical, the results of restrictive operations like the vertical banded gastroplasty (VBG) and the gastric bypass (RYGB) are impressive with patient losing 60 and 80% of their excess body weight respectively.  Even more impressive is that all of the medical problems associated with obesity improve or complete resolve with weight loss.  Most patients will feel that they have a "new lease" on life after the weight loss.

In 2003, there were over 100,000 gastric bypasses performed.  The risk of these operations is significant with 1 in 5 patients suffering a major complication and the wound complication rate in patients undergoing open surgery is nearly 1 in 3.  The wound complications consist of hernias, seromas, infections, and dehiscences.  The laparoscopic gastric bypass still has the same risks as the open operation, however the patients will have less pain, a quicker return to activities, a shorter stay in the hospital, and the wound complication rate drops to 1 in 20. The popularity of surgical procedures for morbid obesity is apparent in the weekly newspapers and there will be over 100,000 of these procedures performed in the U.S. alone this year. 

Gastrointestinal Surgeons

Mary Lou Patton, MD

Linwood Haith, MD

Thomas O'Dea, MD

Dennis Cronin, MD

Allen S. Gabroy, MD

Patrick Elliott, MD

Kenneth Boyd, MD

Samir Parikh, MD

Joan Huffman, MD
Leon Katz, MD

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