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Surgical Disease of the Stomach and Duodenum in Infants and Children

The spectrum of diseases of the stomach and duodenum in the pediatric population is broad. Surgical treatment of the pediatric patient requires a thorough understanding and knowledge of developmental biology, in addition to the unique physiologic and pathologic processes. Many congenital anomalies of the stomach and duodenum are identified prenatally or in the neonatal period, while other lesions are acquired and may manifest later in childhood…

Miscellaneous Benign Lesions and Conditions of the Stomach, Duodenum, and Small Intestine

Benign disorders of the foregut originate in the genes and the environment of the stomach, duodenum, and small intestine. Embryologic events orchestrate anatomic and cellular variations that predispose the adult foregut to obstructive and neoplastic conditions. Webs, stenosis, duplications, and a variety of ectopic and heterotopic cellular occurrences are uncommon and may remain asymptomatic until adulthood. Genetic mutations and environmental stressors have a relationship with hyperplasia…

Motility Disorders of the Stomach and Small Intestine

Gastric Motility Anatomy and Physiology The gastric fundus, body, antrum, and pylorus must contract and relax in a coordinated manner to produce satisfactory gastric function and emptying ( Figs. 65.1 and 65.2 ). The thinner fundus receptively relaxes to store food and liquids and then contracts to empty liquids from the stomach. The gastric pacemaker, which is located in the body along the greater curvature, stimulates…

Foreign Bodies and Bezoars of the Stomach and Small Intestine

Foreign Body Ingestion Foreign body ingestion is an unusual occurrence. Foreign body ingestion may be intentional or unintentional. There are several ways to classify and consider foreign body ingestion. One way is by type of object (size and shape). Foreign body ingestion may also be considered according to age groups. It is well established that 80% to 90% of ingested foreign objects will pass through the…

Operations for Morbid Obesity

Bariatric surgery had its beginnings in the 1950s when malabsorptive operations were performed upon patients with severe hyperlipidemia and obesity. Edward Mason was undoubtedly the father of American bariatric surgery, having first described the gastric bypass in 1969 and later the vertical banded gastroplasty (VBG) in 1981. In between, unfortunately, the field suffered a major initial setback from which it took decades to recover. The culprit…

Postgastrectomy Syndromes

Up to 30% of patients who have had operations on the stomach are afflicted with chronic symptoms that have been relegated to the category of postgastrectomy syndromes. This convenient classification is somewhat of a misnomer because some of these patients have not had a gastrectomy (e.g., dumping after a pyloroplasty or fundoplication), and not infrequently the symptom complex for the individual patient does not fit a…

Gastric Adenocarcinoma

Gastric surgery for benign and malignant diseases has decreased significantly over the last few decades, but the multimodal management of gastric cancer requires that the surgeon be well-versed in the medical and surgical facets of care. The purpose of this work is to provide an overview of the management of gastric cancer with specific emphasis on the perioperative care. Epidemiology In 2016, the American Cancer Society…

Zollinger-Ellison Syndrome

Zollinger-Ellison syndrome (ZES) was initially described in two index cases of refractory ulcer disease and diarrhea in 1955 at the Ohio State University. The index patients had recurrent peptic ulceration after multiple gastric operations, requiring complete gastrectomy to control their symptoms. ZES is a rare cause of peptic ulcer disease for which a high index of suspicion is required to make the diagnosis. The syndrome is…

Surgery for Peptic Ulcer Disease

Gastroduodenal peptic ulcer disease (PUD) is a common problem with significant geographic variation in prevalence. In Western countries the incidence of PUD has steadily declined. Recent population-based studies have shown a prevalence rate of 4% with 20% of patients having asymptomatic ulcers. In developing countries, the prevalence is much higher. In a recent population-based study from China, 17.2% of the population had endoscopically documented duodenal or…

Access and Intubation of the Stomach and Small Intestine

Intubation of the gastrointestinal (GI) tract occurs frequently in the course of patient care. Enteral access, whether via the nasal or percutaneous route, is procured in the majority of instances for decompression or nutrition. Intestinal access is indicated for diagnostic and therapeutic reasons in a variety of disorders, including bowel obstruction, gastric outlet obstruction, gastroesophageal reflux, GI bleeding, and disorders of motility ( Table 58.1 ).…

Diagnostic and Therapeutic Endoscopy of the Stomach and Small Bowel

Endoscopy is the gold standard for providing visual access to the endoluminal space of the gastrointestinal (GI) tract for diagnostic and therapeutic purposes. As a diagnostic tool, it allows for direct visualization of the mucosal surface and permits the identification of abnormalities including mucosal changes, polyps, strictures, and external compression. As a therapeutic tool, the included instrument channel allows passage for instruments that can sample mucosa…

Anatomy and Physiology of the Stomach

The stomach is a remarkable organ that aids in digestion, regulating nutrition, and controlling appetite. The complex physiologic processes by which the stomach exerts its endocrine and nutritional functions have been researched for decades and there is still much to be learned. This chapter on the anatomy and physiology of the stomach aims to equip the surgeon with the detailed knowledge of not only the gross…

Mesh: Material Science of Hernia Repair

Mesh is defined as a network of interlaced material with a lattice-like structure, which in medicine has become synonymous with use for reinforcement of hernia repairs. Mesh use has become ubiquitous as inguinal hernia repair (IHR) is one of the most common procedures performed in the world. Additionally, IHR is the most common type of hernia operation performed, with an estimated 700,000 performed annually in the…

Lumbar, Pelvic, and Uncommon Hernias

Aside from ventral and inguinal hernias, there are less common hernias of the abdominal wall and pelvis that may come to the attention of a general surgeon from time to time. It is important for the surgeon to have a general knowledge of these defects so that they may be included in the differential diagnosis and treated appropriately (and sometime expeditiously) if needed. These include hernias…

Inguinal Hernia Repair: Open

Inguinal hernia repair is the most common general surgical procedure in the United States with approximately 800,000 performed annually. Throughout its long history, many techniques have been proposed for the repair of inguinal hernias. Modern-day repair of inguinal hernias is based on the tenets of minimizing tension and the use of mesh to provide a lasting repair. In this chapter, we review the most common techniques…

Inguinal Hernia Repair: Laparoscopic

Inguinal hernia repair is a frequently performed operation, and laparoscopic inguinal hernia repair has become increasingly prevalent, particularly for the repair of bilateral or recurrent hernias. The first described laparoscopic inguinal hernia repair was completed in 1990 by Ger in canines ; the procedure has since evolved to include the use of a prosthetic mesh to cover the myopectineal orifice. There are two commonly performed techniques:…

Ventral Hernia and Abdominal Release Procedures

Ventral herniation presents a set of common, yet diverse and complex problems in the surgical world. It is a surgical disease with wide variation in management, variable outcomes, and high volumes. More than 2 million laparotomies are completed in the United States every year, and it is estimated that up to 28% of these will develop into ventral incisional hernias. Adding an additional 20% or more…

Congenital Diaphragmatic Hernia

Ladd and Gross reported the first successful series of surgical repair for congenital diaphragmatic hernia (CDH) in 1940, followed by successful neonatal repair in 1946. Gross subsequently reported the largest series of the time in 1953. The reported survival was 87%, but there was significant survivor bias, as many patients with rapid demise from severe lung hypoplasia and pulmonary hypertension were not included. From that time…

Basic Concepts and Factors Associated With Ventral Hernia Recurrence

A hernia is described as a protrusion of an organ or tissue from its normal cavity. This protrusion may extend outside the abdominal wall or between body cavities. Hernias vary in presentation including congenital, umbilical and epigastric hernias, inguinal, traumatic flank hernias, and incisional hernias to name a few. In addition, hernia etiology may differ based upon type. A congenital hernia, present at birth, is the…

Management of Esophageal Perforations and Leaks

The incidence of esophageal perforations is on the rise. Iatrogenic causes remain the most common and continue to increase in an era of frequent use of endoscopy for diagnostic and therapeutic procedures. Despite many advances in care, the mortality rate for an esophageal perforation remains high, with some series citing 12% to 50%. The esophagus passes through the neck, chest, and abdomen, so surgeons managing perforations…