Gastrointestinal surgery in Tijuana

What gastrointestinal surgery covers

Gastrointestinal surgery treats disease of the digestive tube and the organs that accompany it. By region: the oesophagus — gastro-oesophageal reflux disease (GERD), hiatal hernias, oesophageal cancer; the stomach — gastric cancer, ulcers, complicated gastritis; the small bowel — obstruction, Crohn's disease, tumours.

And the rest: colon and rectum — colorectal cancer, diverticular disease, ulcerative colitis; the liver — hepatic cysts, abscesses, tumours; gallbladder and bile duct — stones, polyps, gallbladder cancer; and the pancreas — pancreatitis, tumours. Each region has its study of choice and its own decision logic.

How a digestive problem is investigated

The study is chosen from the symptom, not the other way round. Liver and biliary ultrasound is the first study for pain in the right side of the abdomen and suspected stones. Upper endoscopy looks at oesophagus, stomach and duodenum, and allows a biopsy in the same sitting. Colonoscopy does the same for colon and rectum, and is besides the only study that removes polyps while it finds them.

Contrast-enhanced abdominal CT is what organises the picture when a tumour, abscess, obstruction or pancreatitis is suspected. And labs — blood count, liver function, amylase and lipase, tumour markers where relevant — complete it. None is ordered «just in case»: every study should answer a specific question.

When a digestive problem becomes surgical

A good share of digestive disease is treated with medication, diet and surveillance. Mild reflux is managed with proton-pump inhibitors; uncomplicated diverticular disease with diet and follow-up; gastritis by treating the cause. Surgery enters when medical treatment no longer controls the symptom, when a complication appears, or when the diagnosis is a lesion that has to come out.

The four scenarios that do require an operation: the acute complication (perforation, obstruction, bleeding that will not stop, abscess), recurrent disease that has already run through several episodes, a lesion with malignant potential or already malignant, and a disabling symptom that does not respond to properly conducted medical treatment. Outside those, prudence says investigate further, not operate sooner.

What happens in theatre

Most gastrointestinal surgery today is performed laparoscopically: cholecystectomy, fundoplication for reflux, hiatal hernia repair, resection of colonic segments, small-bowel surgery. The incisions are millimetres wide and the camera gives a magnified view of the field that the naked eye does not have.

Open surgery keeps its place in large tumours, in abdomens full of adhesions, in active bleeding and in the unstable patient. And in cancer surgery the objective rules: clear margins and an adequate lymphadenectomy. If that is only achievable by opening, the abdomen is opened. The route is the means, not the end.