Upper GI Surgery in Mumbai

Dr. Harsh Sheth is an experienced Advanced Laparoscopic & Bariatric Surgeon in Mumbai. With an accumulated experience of 10 years, Dr. Harsh Sheth has performed various basic and complex GI surgeries, laparoscopic surgery and bariatric surgery in Mumbai with a high rate of success. He advocates minimally invasive surgeries to resolve even the most critical gastrointestinal issues for early recovery and least possible trauma.

What does upper GI refer to?

The upper gastrointestinal (GI) tract includes the esophagus or the food pipe, stomach and the duodenum. Serious disorders in the GI tract may cause poor health condition in the patients. These patients could develop esophagus ulcers, hernias and cancers.

What is Upper GI surgery?

Surgery on the upper GI tract is the most preferred line of treatment especially after the failure of lifestyle changes and nonsurgical treatment to resolve GI disorders such as gastroesophageal reflux disease (GERD), duodenitis, inflammation of the stomach, ulcer, issues that affect or restrict the mobility of the esophagus, cancers and so on.

The GI surgeon may recommend laparoscopic (keyhole) surgery etc. across the GI tract to repair, remove or restore the affected organs and help the patient to better health conditions.

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Upper GI disorders and their surgical treatment

1. Achalasia and other motility disorders

Achalasia is a rare upper GI disorder wherein the nerves of the esophagus are damaged. The patient finds it difficult to pass food and liquid through the esophagus into the stomach. The patient complains of spasms of severe chest pain and regurgitates food on lying down.

Dr Harsh Sheth and his team could suggest surgical options to treat Achalasia and other motility disorders viz.

Laparoscopic Heller Myotomy – It is a keyhole operation in which Dr Harsh Sheth will make way food to pass easily in the stomach. He will cut the muscle on the lower end of the esophageal sphincter, allowing the food to pass easily into the stomach.

If performed by laparoscopy, the Heller Myotomy procedure takes one and a half an hour while the patient must stay in the hospital for two days. The effects of Laparoscopic Heller Myotomy can last for a patient’s lifetime.

2. Barrett's Esophagus

Barrett’s esophagus is a condition in which the lining of the lower esophagus gets damaged mainly due to acid reflux. In a patient suffering from Barrett’s Esophagus, this lining will turn hard and red in colour which is otherwise flat and in pink in colour.

Dr. Harsh Sheth and his team could also suggest reliable options such as routine endoscopic checkups, medications, and endoscopic ablative therapies to treat Barrett’s Esophagus conditions.

3. Dysphagia

In this condition, the patient persistently complains of difficulty in swallowing along with pain. The patient has to take additional effort and time to push the food and/or liquid down into to stomach. Dysphagia can occur in young children as well as adults.

Dr. Harsh Sheth will take into consideration the causes before suggesting treatment options for Dysphagia. Various abnormalities of the esophagus and stomach can lead to dysphagia and the treatment plan varies based on the diagnosis.

Various diagnostic tests may be advised to identify the cause of dysphagia, such as barium swallow, endoscopy, CT scan of the abdomen with oral contrast etc.

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Surgery for Dysphagia

As mentioned above, laparoscopic Heller myotomy and Peroral endoscopic myotomy (POEM) are performed to resolve the swallowing trouble, if blockages are detected at the lower end of the esophageal sphincter. The other options include –

– Esophageal dilation :

The surgeon will try to dilate the esophagus’s width by inflating a balloon through an endoscope inserted in the esophagus. This procedure is also used to treat Achalasia, esophageal strictures or for Schatzki’s ring.

– Use of Stent :

The GI surgeon will insert either a metal or a plastic stent to push open the blockage or widen the narrowed down passage in the esophagus. These stents may be temporarily placed or permanent especially in patients suffering from advanced esophageal cancer.

– Esophageal diverticulum :

Esophageal diverticulum refers to a small sac-like structure protruding outwards in the weakened section of esophageal lining. Its location can be anywhere between the throat and the stomach. The Esophageal diverticulum is known as per its location i.e. at the back of the throat, in the mid-chest or above the diaphragm.

Dr. Harsh Sheth will examine and begin with nonsurgical treatment options such as consuming bland food, thorough chewing, and drinking ample fluids after meals. In the case of non-recovery of the patient from esophageal diverticulum condition, surgical treatment options could include –

Diverticulectomy and cricopharyngeal myotomy: This surgery involves complete excision of the diverticular sac. This surgery is performed on patients diagnosed with a sac located behind the throat, just above the esophagus. This condition is referred to as Zenker’s diverticulectomy.

Endoscopic diverticulotomy (Dohlman procedure): This surgery aims to divide the septum for the free flow of the food from the pouch to the esophagus. Further, performing the surgery will take care of the diverticulum through a minimal invasive staple procedure.

– Esophageal cancer :

Esophageal cancer occurs anywhere within the length of the esophagus. There are two types of esophageal cancer viz. Squamous cell carcinoma occurs in the upper and middle sections of the esophagus while adenocarcinoma occurs in the lower part of the esophagus.

– Esophagectomy :

A portion of the esophagus is removed, and the stomach is pulled up and joined to the remaining esophagus. Dr. Harsh Sheth and his team may use a part of the intestine or colon to make the connection. The surgeon will also remove the lymph nodes if they have been affected by cancer.

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Stomach Cancer

Stomach cancer/gastric cancer is a type of cancer which is likely to go undetected for quite a long time. Adenocarcinoma is the most common type of stomach cancer. It occurs in the glandular cells of the stomach. Other types of stomach cancer are Lymphoma, carcinoid cancer, and gastrointestinal stromal tumor (GIST).

Surgery for Gastric cancer: Dr. Harsh Sheth may suggest surgery to remove cancer in the affected part of the stomach or the entire stomach. The type and extent of surgery depend upon the type, location and stage of the cancer. At the same time, the surgeon will check the condition of the lymph nodes. Different types of surgeries for stomach cancer are –

Endoscopic resection and endoscopic mucosal resection are performed to treat early-stage cancers. The surgeon will remove the tumor and some part of the stomach through an endoscopic procedure.

Partial gastrectomy is done if the cancer is detected only in the upper or in the lower stomach. After removing the affected section, the stomach is reattached to either the esophagus or the small intestine as the case may be to maintain continuity in the gastrointestinal tract.

Total gastrectomy is recommended if cancer has spread all across the stomach. The esophagus is then connected with the small intestine to facilitate eating.

Dr. Harsh Sheth is an expert in performing laparoscopic partial and total gastrectomies. The laparoscopic approach can result in lesser trauma and faster recovery for the patient, without compromising on oncological outcomes.

I. Gastroesophageal reflux disease (GERD) :

In this condition, the stomach acid irritates the lining of the esophagus as it flows back from the stomach to the mouth. Increased frequency of gastroesophageal reflux implies severed GERD, which needs to be treated.

Nissen fundoplication – The GI surgeon will perform a Nissen fundoplication procedure where the upper part of the stomach is wrapped around the lower esophagus. This procedure is done in a minimally invasive manner for better recovery and as a permanent solution from acid reflux.

II. Gastroparesis :

Gastroparesis refers to stomach paralysis. The stomach in this patient cannot contract and hence cannot perform the normal digestion process, leading to digestive disorder. The motility of the stomach is absent or abnormal.

Minimal laparoscopy surgery for gastroparesis includes placing venting tubes to prevent recurring vomiting and dehydration and provide relief to the patient. The GI surgeon may perform a dual channel gastrostomy tube that enables gastric venting and a passage for nutrition supplements to reach the small intestine. The GI surgeon may also sometimes use a percutaneous jejunostomy tube to allow the passage of the nutrients and various supplements.

Depending on the condition of the patient, the surgeon may join the small intestine with the healthy section of the stomach to further help the digestion process.

III. Hiatal hernia :

This is a condition wherein the upper part of the stomach bulges out through the hiatus – a small opening in diaphragm. The esophagus tube passes through the hiatus to reach the stomach. Hiatal hernia repair surgery is the only way to manage a large hiatal hernia. This condition causes heartburn and acid reflux in the patient.

IV. Laparoscopic Hiatal repair surgery :

The GI surgeon may recommend a laparoscopic hiatal repair surgery. It involves pulling down the stomach into the abdomen. The surgeon may have to reconstruct the esophageal sphincter to reduce the size of the opening.

V. Obesity-related GI problems :

There are a host of Obesity-related GI problems viz., gastroesophageal reflux disease, erosive esophagitis, Barrett’s esophagus, esophageal adenocarcinoma, erosive gastritis, gastric cancer, diarrhea, colonic diverticular disease, polyps, cancer, liver disease including nonalcoholic fatty liver disease, cirrhosis, hepatocellular carcinoma, gallstones, acute pancreatitis, and pancreatic cancer which can be handled, restored and managed by an experienced GI surgeon.

Dr. Harsh Sheth is the best GI and Advanced Laparoscopic Surgeon in Mumbai who is well versed with GI surgical procedures. He pays a great deal of attention to resolve obesity-related GI issues with the sole intent of offering the patients yet another chance to enjoy a normal and healthy lifestyle. His approach is to ensure minimal surgical trauma, quick recovery, and convenient management of their medical condition.

Frequently Asked Questions

When do doctors recommend upper GI surgery?
Doctors recommend upper GI surgery if the patient complains of heart burn, abdominal pain and bloating, acid regurgitation, difficulty in swallowing, and so on. Surgery is also recommended in case of evidence of stomach cancer, esophageal cancer and tumors to arrest their spread and for total recovery.
How successful are minimally invasive GI surgeries?

Minimally invasive GI surgeries are more successful when compared to open, conventional surgeries. There are a couple of reasons for the same, viz. small incisions, enhanced magnification of tissues through the laparoscope, less blood loss, and speedier recovery. Moreover, these surgeries enable the surgeon to access the surgical area more precisely and accurately. Hence, doctors recommend minimally invasive surgeries for almost all GI surgeries.

What leads to a hiatal hernia? How is it resolved?

Hiatal hernia could develop due to various reasons such as weak abdominal muscles, smoking, strain on the abdomen, obesity and so on. Hiatal hernia can be reliably repaired through minimally invasive laparoscopic surgery. In many cases, minimally invasive laparoscopic surgery can repair a hiatal hernia completely and efficiently. Also, the surgeon may perform a Nissen fundoplication procedure to provide additional support by securing the upper stomach to the esophagus.

How safe is esophageal surgery?

Like with every surgery, esophageal surgery is associated with its share of risks. Choosing an expert and highly experienced GI surgeon can help minimize the extent of risks. Also, the chosen GI surgeon should explain the procedure thoroughly and clearly.

Why is upper GI surgery recommended for GERD?

GERD is associated with troublesome symptoms which hamper normal lifestyle and routine. Its management requires a lot of effort and lifestyle changes. But in some patients, surgery can be the best solution to develop the required barrier to prevent the flow of food and/or acid from entering the esophagus and causing further damage. In a way, upper GI surgery for GERD offers a long term solution.