Upper gastrointestinal surgery is a sub-specialty within general surgery which focuses on disorders of the oesophagus, stomach, small bowel, liver, gallbladder, biliary tree, pancreas, and spleen. These range from benign conditions such as gallstones and cysts to pre-malignant conditions and cancers. Treatment of upper gastrointestinal cancers is often complex and requires coordination among radiology, gastroenterology, surgery, medical oncology, radiation oncology, and other branches of medicine.

Laparoscopy is a surgical technique where a surgeon gains entry into the abdomen via small incisions ("key hole") around 5-10mm in size. The abdomen is inflated with carbon dioxide gas to create a working space, a slim camera is inserted to visualize the operating space, and special instruments are inserted through ports to perform the surgery. Since its invention in the early 1980's, laparoscopy has advanced substantially and now can be used to perform a wide variety of surgery. In many types of surgery such as appendix and gallbladder removal, laparoscopy has become the standard, while in other surgeries such as hernia repair and cancer resections, laparoscopy can be used in some patients. Due to patient, disease, and technical factors, not all abdominal operations can be done laparoscopically. Your surgeon can discuss if this is an option for you.

General surgery covers some disorders of the liver and biliary system. The most common of these is pain caused by gallstones. These are formed if the gallbladder is not working properly, and the standard treatment is to remove the gallbladder (cholecystectomy). This procedure is usually performed using a laparoscopic (keyhole) approach.

Cholecystectomy is the removal of the gallbladder. It is a very common, and usually quite straightforward operation. Most patients have this done because of gallstones causing symptoms like pain. Removal or attempting to "dissolve" gallstones while leaving the gallbladder inside generally does not work. Most people after cholecystectomy return to a normal life, with no restrictions to activities or diet, and little or no long term ill effects. Cholecystectomy is generally done laparoscopically ("key hole"). Very occasionally an open approach ("big cut") may be needed. Surgery is done under general anaesthesia ("asleep"). Some patients can go home the same day after surgery, while others stay overnight.

A hernia exists where part of the abdominal wall is weakened, and the contents of the abdomen push through to the outside. This is most commonly seen in the groin area but can occur in other places. The need for surgery depends on symptoms, and risk of complications. While the lump that the patient feels may come and go, the actual hernia will not resolve by itself, and surgery is the only definitive cure. Surgical treatment is usually quite straightforward and involves returning the abdominal contents to the inside and then reinforcing the abdominal wall in some way. Hernia operations are usually done under general anaesthesia ("asleep"), but some patients may have them done awake, under spinal anaesthesia or even local anaesthesia. Some patients will stay overnight in hospital, while others can go home the same say (daystay surgery). Inguinal and Femoral Hernia (Groin Hernia) Groin hernias can be repaired via an open or laparoscopic approach. In open surgery an incision is made over the region of the hernia, the hernia is pushed back into position ("reducing" the hernia), and the weakness in the abdominal wall repaired. In laparoscopic surgery, usually 3 small incisions are made to allow a narrow tube with a tiny camera (laparoscope) to be inserted, and small instruments inserted to reduce the hernia and repair the weakness. There are pros and cons to each approach. The use of prosthetic mesh is common and your surgeon can discuss the benefits and risks of using mesh. Umbilical and Epigastric Hernia Hernias can occur around or above the umbilicus (belly button). Most of these are repaired by making an incision over the hernia, reducing it and repairing the weakness in the abdominal wall. The use of prosthetic mesh is common and your surgeon can discuss the benefits and risks of using mesh. Incisional Hernia Incision hernias occur under a site of previous abdominal wall surgery, including incisions in the midline of the abdomen, above the pubis (such as after caesarean section or gynaecological surgery), and ports sites from previous laparoscopy. These can be repaired in an open fashion, or laparoscopically. The use of prosthetic mesh is common and your surgeon can discuss the benefits and risks of using mesh. Diaphragmatic Hernia Diaphragmatic hernias occur through the diaphragm. This may allow some abdominal organs to push through the weakness into the chest. A special type of diaphragmatic hernia is a hiatus hernia, which is very common and may or may not need surgery. Repair of diaphragmatic hernias may be done open or laparoscopically, and is often more complex than abdominal wall hernias. Recurrent Hernia Hernias can come back after surgical repair, sometimes months or years later. These can be repaired again, using a similar or different method.

Liver resections involve removing part of the liver. The liver is an essential organ but has a remarkable reserve and ability to compensate. Contrary to popular belief, the liver does not "grow back" after surgery. However the remaining liver gets bigger. Reasons for liver resections include benign tumours and cancers, including primary cancers arising within the liver, and cancers having spread to the liver from somewhere else ("metastases"), most commonly from the bowel. Liver resections range from relatively minor, to very complex and major, requiring long hospital stays and sometimes intensive care. Some liver resections can be performed laparoscopically ("key hole"). Occasionally, liver resections can be combined with ablations, where energy devices such as microwaves are used during the operation to destroy some tumours. Treatment of liver cancers is complex and requires coordination across specialties including radiology, gastroenterology, surgery, and oncology.

Pancreatectomy involves removing part of, or the whole pancreas. These are complex operations, often with a high level of technical difficulty, risks, and side effects. Common types include the Whipple procedure, distal pancreatectomy, and total pancreatectomy. These are mostly done for cancers or pre-malignant conditions. Some pancreatectomies can be done laparoscopically ("key hole").

Splenectomy is an operation to remove the spleen. The spleen is a non-essential organ that has some function in the haematological (blood-forming) system of the body, and in the development of the immune system. Its function is more important in children, and less so in adults. Splenectomy is most commonly performed for disorders of haematological system. This can be done open or laparoscopically ("key hole"). We commonly recommend specific vaccinations before or after splenectomy.

Gastrectomy involves removing part of, or the entire stomach. This may be done for benign conditions such as damage from severe ulcer disease, tumours with malignant potential, or cancers. This can be done open (big incision), or laparoscopically ("key hole"). Gastrectomies range from relatively minor, with little or no long term effects to the patient, to quite major. Treatment of gastric cancer is complex and requires extensive investigations and coordination among specialiaties including radiologists, gastroenterologists, surgeons, and oncologists.

Antireflux surgery are operations to treat gastro-oesophageal reflux disease (GORD). GORD is a common condition due to reflux of acid from the stomach into the oesophagus. Symptoms are variable, from asymptomatic, to relatively minor and controlled by lifestyle changes or medication, to severe and unresponsive to medication. Patients with GORD sometimes also have a hiatus hernia, which is when part of the top of the stomach slips up into the chest due to a widened weakness in the diaphragm (the "hiatus"). Antireflux surgery usually involves fixing the hiatus hernia and performing a fundoplication, where a floppy part of the stomach is used to form a "wrap" around the oesophagus, reducing acid reflux. These operations are often done laparoscopically ("key hole").

Robotic surgery is a recent modification to laparoscopic surgery. In this technique, a robot holds instruments similar to those used in laparoscopic surgery, modified to increase precision and dexterity. The surgeon then controls the robot from a console next to the operating bed. This helps overcome some of the technical challenges with laparoscopy, and has the potential to increase the range of surgery and number of patients suitable for minimally invasive operations.

Upper GI endoscopy ("gastroscopy") is a minimally invasive diagnostic procedure commonly used to examine the inside of the upper gastrointestinal tract, including oesophagus, stomach, and duodenum. Indications for this procedure includes abdominal pain, gastrointestinal bleeding, acid reflux, and benign and malignant tumours of the upper GI tract.