Gastrointestinal surgery or GI surgery encompasses many procedures done on the organs of the GI tract.  The GI tract within the abdomen includes the stomach, small intestines and colon.  There are a number of conditions that can take place anywhere along this tract that may require surgery.  A small portion of them are covered here.  


Stomach


The stomach is the first portion of the GI tract within the abdomen.  It is an organ that receives food from the esophagus within the chest and has a major role in the initial digestion of food, particularly proteins.  The normal structure of the stomach is complex.  It is composed of muscle important in physical churning of food.  Additionally, the inside lining of the stomach is made up of small folds called rugae that expand as food enters into the stomach to allow for large quantities of food to be stored as it undergoes initial digestion.  The stomach also makes gastric juice which is the main mechanism by which food is digested.  The juice is made up of many things including hydrochloric acid (a strong acid that breaks down food and other foreign materials) and pepsin (an enzyme used to digest protein).  Because of the highly caustic nature of the acid the stomach protects itself with an inner lining against the acid so that the stomach itself doesn't get digested.  The stomach also has barriers within it to prevent acid from moving up into the esophagus (lower esophageal sphincter) and into the first portion of the intestines known as the duodenum (pyloric sphincter).


Feeding Tube (aka Gastric Tube, G-Tube, PEG Tube)


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Small Intestines


The small intestines is the portion of the GI tract between the stomach and colon.  This is where additional digestion takes place but where most of the absorption of food takes place.  Digestion is aided by bile and pancreatic juice which will enter the intestines. There are three portions of the intestines including the duodenum, jejunum and ileum.  In the average adult the intestines measures almost 25 feet.


There are many issues that can take place as a result of the small intestines.  As surgeons we often encounter people who have a small bowel obstruction.  This is essentially a condition in which a portion of the small intestines has become twisted or kinked resulting in people having cramping abdominal pain with associated distension of the abdomen and nausea with vomiting.  The twist or kink does not allow food, air and digestive juices through resulting in the above symptoms.  This can be a result of hernias in which small bowel becomes trapped and twisted off or as a result of scar tissue from previous abdominal surgeries that can cause mechanical twisting.  Less often it is a result of a mass or tumor within the small intestines.   Management of this condition usually requires admission into the hospital with fluids and electrolytes given through an IV for dehyrdration and decompression of the GI tract using a nasogastric tube (NG tube) which will suction out the food, digestive juice and air trapped within the upper portion of the GI tract.   A vast majority of the time these maneuvers will treat the obstruction and the GI tract will open up on its own.  However, in some instances a surgery is necessary in order to identify the kink and remove involved bowel that may have died.  Should the obstruction be secondary to a hernia or mass this will almost always require a surgery.  Additionally, if a person has never had surgery before and presents with an obstruction a surgery is often necessary to determine the cause.  


Finally, small intestinal tumors may require surgery as a result of symptoms they may cause and potential cancer within them.  Often times, tumors of the small intestines go unnoticed until they cause symptoms of obstruction or bleeding in which case they are identified and removed with a surgery.  Tumors of the small bowel include the following:


  • ​Adenocarcinoma (primary cancer of the small intestines)
  • Carcinoid (slow-growing neuroendocrine tumor that may cause symptoms of excess hormone release)
  • Gastrointestinal Stromal Tumor (GIST) (tumors that arise from the nervous system of the intestines and can be found anywhere along the GI tract including the stomach)
  • Lymphoma (usually treated with chemotherapy and/or radiation as opposed to surgery)
  • Sarcoma (arise from the smooth muscle layer of the intestines)
  • Leiomyoma, adenomas, lipomas (benign tumors of the intestines)


When encountered surgical intervention with resection of the portion of the small bowel is usually involved.  After resection the two cut ends of the intestines are brought back together using staples or sutures.  


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Feeding Tube Insertion

Small Intestine Surgery Appendix Removal​

Gastrointestinal Surgery