Overview
The Upper Gastrointestinal Surgery Program offers surgical treatment for the full spectrum of benign gastric and esophageal disorders. The program performs approximately 60 cases per year, making it one of the largest benign foregut surgery centers in Canada. Our surgical team have extensive training in minimally invasive surgery, and virtually all patients can be offered a minimally invasive approach.
Treatments Offered
The program performs approximately 100 benign gastro-esophageal procedures each year, including many emergency cases. As a major referral centre, the program also performs a large number of complex and revisional (redo) cases, many of which come from across Quebec and even out-of-province. Conditions treated by the program include:
* Achalasia & Epiphrenic Diverticulum
Overview
Achalasia is a disease of the esophagus in which the esophageal muscles fail to contract to move food down and the valve at the bottom of the esophagus fails to open to allow food to pass to the stomach. The result of achalasia is severe difficulty swallowing. Sometimes this can be associated with a pouch developing in the lower esophagus due to pressure; such a pouch is called an "Epiphrenic Diverticulum" and can cause discomfort, bad breath and regurgitation of food. The cause of this disease remains unknown.
Achalasia and Ephiphrenic Diverticulum are diagnosed by gastroscopy, barium swallow and a specialized test that measures esophageal muscle function (called an esophageal manometry test).
Surgical Procedure
Surgery for achalasia involves opening the valve at the bottom of the esophagus so food can pass to the stomach. This procedure is called a Heller myotomy. There is no treatment that restores the ability of the esophageal muscles to push food down, so swallowing after achalasia surgery will always depend on gravity. When the valve is opened, there is risk of stomach contents and acid refluxing into the esophagus, so an anti-reflux procedure is usually performed at the same operation. If an Epiphrenic Diverticulum (pouch) is present, it is removed at the time of surgery.
Laparoscopy (keyhole surgery using small incisions) is the preferred method by which to perform a Heller myotomy. This approach minimizes pain after surgery and helps speed聽recovery. The esophageal valve muscles are cut and the anti-reflux procedure performed. Swallowing usually improves immediately after surgery and patients can progress to a normal diet almost right away. If liquids pass normally, a solid diet can be attempted 1-2 days after surgery.
* Hiatal (Para-esophageal) Hernia
Overview
A hiatal hernia occurs when a part of the stomach bulges through the diaphragm beside the esophagus. Small hiatal hernias involve only the top of the stomach. In larger hiatal hernias (known as para-esophageal hernias), a large part of the stomach and even other abdominal organs such as the colon, spleen or pancreas can be involved in the hernia. These develop due to a weakness in the diaphragm muscles. Like all other hernias, they tend to grow larger over time.
Reasons for Surgery
When small, hiatal hernias often cause only reflux symptoms that can usually be controlled with medication. These only require surgery if the reflux is severe. Large para-esophageal hernias however can cause stomach bleeding, regurgitation of food, and twisting of the stomach which can be very dangerous. Paraesophageal hernias require repair in most cases.
Surgical Procedure
Laparoscopy (keyhole surgery using small incisions) is the preferred method by which to repair hiatal hernias. This approach minimizes pain after surgery and helps speed recovery. The operation involves returning the stomach back into the abdomen and closing the hole in the diaphragm with sutures. Swallowing may be affected for a period of time after surgery, but usually normalizes by 2-8 weeks. Patients must adhere to a liquid diet immediately after surgery and slowly progress to solid food as their swallowing improves.
* Gastroesophageal Reflux Disease
Overview
Severe reflux (鈥渉eartburn鈥�) occurs when the valve at the bottom of the esophagus is weak, allowing stomach acid to reflux up into the esophagus. This may also occur with hiatus hernias. When the valve is very weak, undigested food can also reflux into the esophagus, known as regurgitation. Symptoms are often worse when lying down or bending over. Many reflux symptoms can be managed with lifestyle and dietary modifications, such as avoiding coffee and alcohol, not eating spicy food, elevating the head of the bed during sleep and not eating late at night. Medications are also used to reduce stomach acid.
Reasons for Anti-Reflux Surgery
Patients who experience severe reflux despite lifestyle and dietary changes and maximal medications may benefit from surgery to reinforce the valve at the bottom of the esophagus. Other reasons for surgery include intolerance or allergy to antacid medications, not wanting to take medications for life or risk forgetting doses, inability to adhere to numerous lifestyle and dietary changes, or regurgitation of food when bending over or lying down.
Surgical Procedure
Laparoscopy (keyhole surgery using small incisions) is the preferred method by which to perform anti-reflux surgery. This approach minimizes pain after surgery and helps speed recovery. The operation involves using a part of the stomach to reinforce the valve at the bottom of the esophagus. If there is a small hiatus hernia present, it will be repaired at the same time.
The procedure eradicates the need for antacid medications in the majority of patients, and reduces reflux symptoms to a tolerable level in the remainder. Swallowing may be affected for a period of time after surgery, but usually normalizes in 4-8 weeks. Patients must adhere to a liquid diet immediately after surgery and slowly progress to solid food as their swallowing improves.
* Zenker's Diverticulum
Overview
Zenker's Diverticulum is pouch that forms in the part of the esophagus just past the mouth (in the neck). This usually occurs due to a weakness in the esophageal muscles. Over time, the pouch gets larger and larger due to pressure and food accumulation. Larger pouches cause difficulty swallowing, bad breath or taste in the mouth, and coughing or choking when eating.
Reasons for Surgery
A Zenker's diverticulum that causes symptoms, especially difficulty swallowing, choking or frequent pneumonias, requires surgery to treat.
Surgical Procedure
Several options exist to repair Zenker's Diverticulum, and the type of repair depends mostly on the size of the pouch. All repairs are done under general anesthesia in the operating room, and most procedures can be done as day surgery. In many cases, the pouch can be fixed through the mouth without the need for any incisions. If this is not possible, the pouch can be treated through a small incision in the neck. Swallowing is better almost immediately after surgery and most patients can resume a normal diet within a few days after the procedure.
Contact Information
Upper Gastrointestinal Surgery Program
Montreal General Hospital
1650 Cedar Avenue, Room L8-505
Montreal, Quebec H3G 1A4
Tel: 514-934-1934 x 44327
Fax: 514-934-4432
