Gastrointestinal Surgery Cost

Management of obesity-related medical problems costs Americans more than 30 billion annually. This does not take into account the amount of money spent on dieting and dietary supplements. The cost of bariatric surgery varies in different parts of the United States and depends on the extent of the preoperative evaluation. At our institution, the average cost for the uncomplicated patient is approx 12,000. If the procedure is done laparoscopically, it may add 2,000- 3,000 to the cost of the...

Types of esophageal stents

Currently, there are three esophageal stents used in the United States. They are as follows (Table 1). Gianturco Z-stents are made from 0.018-in stainless steel wire bent in a zig-zag fashion to form segments 2-cm long, which are connected using nonabsorbable suture to form lengths from 6 to 14 cm. The stent is 18 mm in its internal diameter, with the proximal and distal ends flared to 25 mm. The Z-stents are available in fully covered and 1Gianturco Z-Stent (Wilson-Cook Medical, Winston-Salem,...

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Nissen fundoplication, complications, 41-43 contraindications, 38 fundoplication options, 38, 40, 41, 43, 47 hiatal hernia repair, 47 indications, 37 laparoscopic technique, advantages over open development, 33, 34 procedure, 39 outcomes, 41 postoperative care, 41 preoperative evaluation, 38 transabdominal approach, 33, 38 Nonsteroidal anti-inflammatory drugs (NSAIDs), peptic ulcer disease, 83 NSAIDs, see Nonsteroidal anti-inflammatory drugs gastric bypass, see Bariatric surgery medical...

Longterm Complications Of Hepatic Resection

Despite the myriad of possible acute complications associated with hepatic resection, there are few long-term sequelae once the liver has regenerated. There is no particular evidence that the regenerated hepatic parenchyma is more fragile or susceptible to hepatotoxic drugs. Repeat hepatic resection may even be done safely if the indications and circumstances warrant it (18-20). Patients certainly can develop wound problems such as hernias or chronic pain. They infrequently develop biliary...

Complications and Management

The rate of complications following LAR has been reported as high as 41 (5). Most of these are common to most major abdominal procedures and would include atelectasis, urinary tract infection, wound infection, and deep venous thrombosis. Significant complications specific to LAR include anastomotic leakage, anastomotic stricture, and imperfections of continence or bowel habit. Leakage from the anastomosis after LAR Fig. 1. Use of a circular stapler to create an anastomosis. (A) Resection of...

Complications Of Urinary Diversions And Their Managements

Using the intestine as a substitute for the urinary bladder can lead to significant complications. The bowel epithelium is an absorptive surface, whereas the transitional epithelium is relatively impermeable to most substances. Any urinary diversion that utilizes bowel will absorb, to some extent, urinary solutes. With the exception of stomach, the more proximal the bowel segment, the greater the reabsorption characteristics. The degree of such absorption is proportional to the duration of...

Complications and management of peptic ulcer surgery Early Complications

The generic complications seen with gastric surgery are hemorrhage and infection. The most feared complication is suture line leakage, especially at the duodenal stump. Mechanical complications include anastomotic obstruction, jejunal volvulus, and afferent loop and efferent loop syndrome. Postoperative ileus can result in acute gastric dilatation. Gastric necrosis is unusual, but is occasionally seen (1 in 400 cases) with proximal gastric vagotomy owing to the extensive devascularization of...

Physiological Changes

Frey procedure. (A) Excavation of head of pancreas. (B) Creation of enterostomy. (C) Side-to-side pancreaticojejunostomy. Fig. 6. Frey procedure. (A) Excavation of head of pancreas. (B) Creation of enterostomy. (C) Side-to-side pancreaticojejunostomy. Usually, patients with normal pancreatic function preoperatively can tolerate an 80 pancreatic resection without significant physiological changes. On the other hand, patients with diffuse parenchymal disease as seen with chronic...

Surgical Anatomy

The liver has a dual blood supply, which enters it as a single portal cable. The portal vein normally supplies approx 80 of the blood flow to the hepatocytes. The hepatic artery supplies a smaller percentage, but is an important source of blood flow to the biliary tree. Venous drainage occurs via the hepatic veins, which empty into the inferior From Clinical Gastroenterology An Internist's Illustrated Guide to Gastrointestinal Surgery Edited by George Y. Wu, Khalid Aziz, and Giles F. Whalen...

Indications and Contraindications

The most common indication for a pancreaticoduodenectomy is resection of a tumor of the head, neck, or uncinate process of the pancreas or periampullary tumors. Another indication is chronic pancreatitis with imflammatory changes localized to the head of the pancreas. Preoperative evaluation includes imaging for diagnosis, as well as staging and determination of resectability. The most common imaging modalities used include transabdominal ultrasound, endoscopic ultrasound, computed tomography...

Complications

Complications include urinary retention, urinary tract infection, bleeding, anal stenosis, incontinence, fecal impaction, infection, and fistula formation. Local infection and fistula formation are quite uncommon, easily recognized, and generally treated in the office with drainage or superficial fistulotomy. Urinary retention is generally secondary to both local pain and the amount of intravenous fluids received intraoperatively. Rates Fig. 7. Surgical hemorroidectomy. (A) Exposure of the...

Indications for procedure

Gastric Volvulus Organoaxial

The majority of sliding hiatal hernias are asymptomatic. Only when surgical intervention is indicated for GERD should Type I (sliding hiatal hernia) be repaired (see Chapter 3) (2). The presence of Type II paraesophageal hiatal hernias has traditionally been considered an indication for surgery in a patient who is otherwise fit for surgery. Paraesophageal hiatal hernias have been associated with the risk of strangulation of incarcerated viscera and the potential need for emergency operations....

Types Of Hepatectomy Resections

Right Hepatectomy With Ehbte

Although 75 of a normal liver may be resected with a reasonable expectation that enough hepatic function will remain to support regeneration of the hepatic remnant, this percentage is significantly reduced when the liver parenchyma is diffusely diseased. A larger hepatic remnant will be necessary to support regeneration and reduce the risk of fulminant hepatic insufficiency. Typically, when more than 50 of the functional capacity of the liver is removed, the possibility of liver failure becomes...

Current surgical treatment of ulcer complications

Posterior Gastric Ulcer Artery

The primary treatment of bleeding ulcers is endoscopic control followed by treatment for H. pylori if present. Even rebleeding is best treated by repeat attempts at endoscopic control (4). Surgery is indicated for significant bleeding (requiring over five units of blood) that cannot be controlled by endoscopy. Most uncontrolled bleeding ulcers are from the gastroduodenal artery in the posterior aspect of the duodenal bulb. Treatment is by duodenotomy, and ligation of the bleeding site (Fig. 6)....

Short Bowel Syndrome

Short bowel syndrome (SBS) has been defined as having an inadequate small bowel length with associated malabsorption. The syndrome is characterized by watery diarrhea, dehydration, fluid and electrolyte abnormalities, and malnutrition. SBS usually occurs if greater than 70 of the small bowel has been resected or if less than 180 cm of the small bowel remains (9). These numbers vary depending on whether it is jejunum or ileum remaining, with the latter being preferable. Preservation of the...

Hiatal Hernia Repair

Brams, md The history of surgery for hiatal hernia and gastroesophageal reflux disease (GERD) has paralleled our gradual understanding of the physiological features of the esophagus. The association between GERD and esophagitis was not established until the 1940s, and much controversy arose concerning the relationship between hiatal hernia and GERD. Initial attempts at simply reducing the hernia by closing the crura proved to have unac-ceptably high failure rates....

Peg Vs Radiological Or Surgical Gastrostomy

Although studies have shown no difference in morbidity and mortality when comparing surgical gastrostomy to PEG (9), PEG tube placement has been found to be more cost effective and offers the advantage of reducing operative and recovery time. Operative gastrostomies should be reserved for patients in whom endoscopy cannot be performed or when an anatomic aberration precludes a safe percutaneous approach, or for patients who are going to the operating room for another surgical procedure. The...

Surgery for Gastroesophageal Reflux Disease

Brams, md Introduction Pathophysiology of Gerd Symptoms of Gerd Indications for Surgery Contraindications to Surgery Preoperative Evaluation Laparoscopic Fundoplication Conduct of Operation Gastroesophageal reflux disease (GERD) is one of the most common problems seen in medical practice. Approximately 10 of the U.S. population experiences heartburn daily, and 40 of the population has heartburn monthly. Seven percent of the population (40 million individuals) use...