Visceral surgery deals with surgical procedures on the abdomen and the organs within it. It is also called abdominal or abdominal surgery. It takes its name from the Latin word “viscera” meaning “intestines.”
What is visceral surgery?
Visceral surgery is where a hospital sees patients who require surgery on their abdominal organs, such as the stomach, esophagus, liver, digestive tract and so on. This also includes transplantation of organs, reconstruction after an accident, removal of benign or malignant tumors, treatment of inflammation, diagnostics, etc. Diseases of the tissue structures surrounding the organs also belong to the field of visceral surgery. Further training to become a visceral surgeon takes four years. Throughout Germany, the distinction between the further training courses “general surgery” and “visceral surgery” is not uniform. However, while the general surgery department of a hospital includes all surgical procedures on the entire body, visceral surgery wards only deal with abdominal operations. In addition, visceral surgery wards often specialize, for example, in tumor and/or metastasis therapy, operations on the intestines, the esophagus, transplants or some other sub-area. Specializations in very specific areas are also possible. For example, some hospitals have colon or pancreatic cancer centers and the like.
Treatments and therapies
Visceral surgery procedures typically include appendectomies, liver transplants, removal of tumors or metastases in the abdomen, gastric surgery, gallbladder removal, etc. Accidents can also cause trauma to organs that require surgical reconstruction. Malformations of organs in the abdominal cavity already present from birth are also treated in visceral surgery. In some cases, when antibiotic treatment is not advisable or would no longer be sufficient, surgical intervention may also be required in cases of inflammation. In this case, the inflammatory tissue is cut out and thus removed. Since inflammation can occur anywhere in the body, any organ in the abdomen can be affected. Often, a visceral surgeon must perform procedures on the stomach. Here, gastric carcinoma, gastric perforation or gastric ulcer, among others, can be the causes that require surgery. In the case of carcinoma and ulcer, surgical treatment consists of removal if possible; in the case of gastric perforation, the perforation is sutured over. Visceral surgical interventions on the intestine represent, for example, the removal of malignant tumors or polyps, as well as real or fake diverticula. Diverticula, or protrusions, are called “true” when they involve both the mucosa and the intestinal wall. “Inauthentic” diverticula are those in which only the mucosa protrudes. Intestinal obstruction can also be treated surgically, depending on the cause. If medication is not indicated, which is the case, for example, with mechanical causes such as an adhesion strand, surgery can be performed, usually minimally invasive. Diseases of the gall bladder are also treated by means of visceral surgery. These include, for example, bile duct carcinomas and gallstones. If gallstones cause symptoms, the entire gallbladder including the stones is removed, depending on the case. In the case of bile duct carcinoma, surgical removal may or may not be advised, depending on the degree of disease and metastasis. Diseases of the spleen that may require surgical intervention include splenic infarction or splenic rupture. In splenic infarction, the spleen is undersupplied due to occlusion of the lienal artery, an artery in the abdominal cavity. In this case, surgical removal of the spleen is the only treatment option in the event of a complete infarction. Splenic rupture, i.e. rupture of the spleen, is in most cases caused by blunt force trauma to the abdomen. Depending on the degree of injury, conservative treatment may be used. However, in more severe cases, surgery up to and including removal of the spleen may be necessary.
Diagnosis and examination methods
In addition to procedures to treat medical conditions, diagnostic surgical procedures are also part of a visceral surgeon’s scope of practice.Here, as often as possible, attempts are made to use minimally invasive methods, such as laparoscopic surgery, also called “buttonhole surgery” or laparoscopy. In this procedure, only very small incisions are made (approx. 0.3 – 2 cm), through which thin tubes with a camera attached at the front are pushed into the abdominal cavity or to the organ to be examined. To facilitate access, the abdominal cavity is usually filled with gas for this purpose. This allows for greater room to maneuver around the organs. The image from the camera is transmitted to a screen. This allows doctors to view organs directly and then advise on diagnosis and treatment. Minor surgery can also be performed using laparoscopy because not only cameras, but also small surgical tools on tubes can be inserted through the small incisions. This type of surgical procedure is much gentler on the organism than other procedures of conventional surgery, such as abdominal incisions. In these, a large incision is made on the abdominal wall, resulting in a higher complication rate. The large wound increases the likelihood of inflammation, healing takes longer, and the overall trauma to the body is also greater. In some cases, however, abdominal incisions are still necessary, for example, for surgery on “more hidden” organs, such as the pancreas. Also, the operability of, for example, a bile duct carcinoma can often only be assessed during the operation itself, so that a “probelaparotomy” is performed. Thus, in such a case, the abdominal incision represents a component of the diagnostic procedure, even though the therapy – if the tumor proves to be operable – can take place immediately in the form of surgical removal of the tumor.
