GENERAL MEDICINE

It is a technique which is very similar to the Bypass but there are two details that differentiate it. The first is that the gastric reservoir is somewhat longer and the second is that the intestine is not sectioned. Thus, the intestine is connected (anastomosed) to the stomach (see drawing).

As for the loss of appetite and the chances of losing weight, they are similar to those of the bypass. It has some advantages: shorter surgical time, fewer mechanical sutures and fewer complications since there are fewer junctions and section surfaces.

On rare occasions (0.4%), an alkaline reflux may appear that forces the minibypass to turn into a bypass. It is an uncomplicated operation from a surgical point of view.

This intervention instructions are the same for the bypass, excluding cases in which there is esophagitis due to gastroesophageal reflux.

It is a restrictive technique, that is, those that reduce the stomach capacity without adding another malabservative gesture..

This technique consists in resecting a large part of the stomach, turning it into a narrow tube..

In the first 2-3 years, this technique leads to the loss of appetite due to the removal of the part of the stomach that produces a hormone called ghrelin, responsible for it.
Since ghrelin can also be secreted in other areas of the intestine, hunger may reappear over time. However, it will be very different since the patient would be satisfied with his weight loss and would have learned from his previous situation.

This operation is indicated in patients with low BMI or, on the contrary, very high, with the intention of subsequently doing a second surgical intervention. It is also recommended for patients with gastric pathology in cases of inflammatory bowel disease and liver disease.

A cholelithiasis refers to the presence of stones in the gallbladder.

In many cases they do not give any symptoms, but when they are symptomatic they produce one of the following diseases: biliary colic, cholecystitis, pancreatitis, jaundice and/or cholangitis.

Surgical intervention is recommended for all patients with symptomatic cholelithiasis, especially in the case of diabetics. The operation is contraindicated, unless it has to be performed urgently, to those who have an advanced lung or heart disease in which the risk of the operation exceeds that of the lithiasis symptomatology.

A hiatal hernia consists in the ascension of all or part of the stomach to the thorax.

There are three types of hernias:

• Sliding hiatus hernia: It is the most frequent. There is a sliding of the gastric cardia to the thorax. They are usually small and can be associated with gastroesophageal reflux (GER).
• Paraesophageal hiatus hernia:It is rare, it consists of the ascension of the stomach to the thorax through the hiatus keeping the cardias in place. It is usually given in 3 year old patients.
• Mixed hiatus hernia: It is a combination of the two previous ones.

The symptoms can be several of them. It may be that the patient experiences a retrosternal burning sensation, vomiting or epigastric pain in the lower part of the chest. In many cases, it is totally asymptomatic and it is discovered during a radiological exploration made by other causes.

Sliding hernia does not have to be operated without symptoms, the most frequent symptom is the gastroesophageal reflux (GER).

Paraoesophageal hernias do get complicated frequently, being able to bleed from an ulcer in the herniated stomach. Gastric obstruction or even strangulation can occur, which is why surgical correction is recommended. It is contraindicated in patients with an advanced respiratory or cardiac disease.

All patients must be operated on in the event that the paraoesophageal hernia is already in an emergency situation.

Gastroesophageal reflux is when gastric contents come back up into the esophagus. It becomes pathological when it occurs several times and increasingly in a day or these refluxes have a longer duration, exposing the esophagus to gastric juice action that will cause the appearance of a more or less severe esophagitis depending on the case.

Reflux, when it is pathological, produces a retrosternal burning sensation (heartburn) and, in more advanced cases, may cause pain when swallowing. Sometimes the patient wakes up at night agitated by a coughing access produced by the acidic gastric juice reflux in the larynx.

Reflux is often accompanied by hiatus hernia.

As for non-cancerous tumors, most are usually small polyps that are removed by endoscopy and correspond to adenomas or hyperplastic polyps..

Another type of tumors that are very often benign are gastric wall tumors, called GIST (Gastrointestinal Stromal Tumors). Tumors smaller than 5 cm are usually benign while tumors larger than 10 cm can be malignant.

The symptoms are usually asymptomatic, sometimes with bleeding and the production of a high digestive hemorrhage. They are diagnosed by means of a gastric endoscopy. When there are no symptoms, they are diagnosed casually in abdominal examinations for other pathologies.

The treatment of these tumors is surgical.

In the case of malignant tumors, it is estimated that the frequency of gastric cancer in our country is 15-24 cases per 100,000 inhabitants per year. Although its frequency has decreased in recent years, it is still the most frequent problem in the digestive tract after the colorectal one.

There are two varieties of cancer: the intestinal type and the diffuse type.

The maximum frequency of presentation is in 60 years.

It is a very silent tumor. When it gives symptoms, it is usually large in size. The symptomatology, when it exists, is same as that of any gastric pathology: pain, bleeding, vomiting due to pyloric obstruction or dysphagia (difficulty swallowing) when it is a high tumor that affects the cardia and invades the esophagus.

The treatment is surgical and the surgery to be applied will depend on the cancer type and state.

Nowadays, stomach ulcers have a medical treatment, they do not need to go through an operating room (assuming there are no complications, such as perforation).

Pyloric stenosis is the difficulty in passing out from the stomach to the first part of the small intestine. If it is due to gastric cancer, this will be treated as described in the corresponding section.

The ulcer can mainly produce vomiting, pestilent belching, significant delay in the evacuation of ingested food to the intestine and reflux (retrosternal burning, reflux).

Intestinal occlusion is the most frequent pathology of the small intestine. It is related to previous surgical interventions. The abdominal intervention creates adhesions and bridles in the peritoneal cavity that often do not give any symptoms but that can cause an intestinal occlusion which causes constant pain that is not quenched with analgesics and is the cause of urgent surgical intervention, evaluating, during the same, the intestine resection if necrosis has occurred. Sometimes, the scar tissue sectioning motivates the recovery of the affected intestine and its resection is not necessary.

The intestinal occlusion is often not total and recovers after a treatment with fluid therapy and emptying of the intestinal contents by means of a nasogastric aspiration.

Intestinal occlusion causes are numerous. The most common are the bridles, but it must be ruled out that the cause is a hernia, a gallstone passing through a fistula between the gallbladder and the duodenum (in this case it is called a biliary ileum), a foreign body ingested, a tumor and others. For this differential diagnosis, it is useful to perform an abdominal CT scan.

If the occlusion is not resolved with the conservative treatment, it will be necessary to resort to surgery if it can be by laparoscopy.

The most important appendix illness is, without doubt appendicitis, one of the most frequent processes in a surgical service’s emergency room.

Appendicitis is characterized by a loss of appetite and abdominal pain. It often starts in the epigastrium and then focuses on the lower right quadrant. After the pain, nausea and vomiting appear. Usually, there is not very high fever.

Unfortunately, the case is not always typical and may be accompanied by diarrhea instead of intestinal closure. The pain may be diffuse and there may be no fever, which can be confused with gastroenteritis.

Chronic constipation is a very common problem in our society. It occurs in all ages; children, teens, adults and elders.

We will talk about constipation when there is scarce stool in less than 3 weeks. The stool is usually hard and dry and is difficult to pass. It creates discomfort for those who suffer from it.

It is usually associated with a sedentary lifestyle and a poor intake of fiber and/or water.

Other constipation causes are colon neoplasia, irritable bowel syndrome, neurological disorders, dolichocolon, medications, etc.

The abundant intake of water, following a diet rich in fiber and exercising are recommended.

However, when suffering is chronic, it is very difficult to reverse.

Diverticula presence in the colon is frequent as age increases. In fact, from the age of 50, more than half of the population has diverticula which can exist at any point in the large intestine.

These diverticula are usually asymptomatic until they become infected, causing a clinical case called diverticulitis. Some people describe it as being similar to an appendicitis on the left side.

Uncomplicated diverticulitis produces continuous pain in the left lower quadrant and is accompanied by a low fever. However, the case may progress to stenosis and occlusion, an abscess formation or perforation of the diverticulum with access to the exit of excrement in the abdomen. Obviously, the clinical case varies according to the complication that occurs, as well as the deterioration of its general condition.

The treatment, in the initial cases, is with oral antibiotics and diet without fiber. In cases where there is an important gumboil, the patient must be admitted for intravenous antibiotic treatment and an absolute diet for a few days, depending on the evolution of the disease.

Colorectal cancer is the cancer that begins in the colon or rectum. It is the fourth cancer in order of frequency in men after those of the skin, the prostate or the lungs. It also occupies the same position in order of frequency in women, after those of the skin, the breast and the lungs.

Cancer risk increases with age, being 0.87% at 50 years and 5.8% at 80 years.

Like other cancers of the digestive tract, it spreads via lymphatic or blood vessels or by contiguity to neighboring organs such as the bladder, the abdominal wall or the vagina, among others.

Regarding the symptoms, in the early stages, colorectal cancer is asymptomatic and if it is discovered at this stage, it is found by chance in a colonoscopy performed for another pathology study or as screening for colorectal cancer by age or family history.

In more advanced stages, chronic anemia, weakness or weight loss symptoms appear. In cancers located in the left colon, obstruction symptoms are more frequent with alteration of the intestinal habit and sometimes rectorrhages (outflow of red blood with or without stool).

Those located in the rectum give an incomplete feeling of evacuation, red blood and / or mucus in the stool.

The treatment of rectal cancer happens with chemoradiotherapy before the intervention if it is demonstrated that the tumor extends beyond the wall of the rectum or the presence of affected lymph nodes.