DEFINITION
Visceral surgery essentially adresses pathologies of the abdominal and pelvic organs.
Visceral surgeons treat not only diseases of the digestive tract but also diseases of the abdominal wall or other non-digestive intra-abdominal organs such as the spleen or endocrine glands like the thyroid.
- Visceral surgery
- Hepatic surgery
- Endocrine surgery
- Obesity surgery
VISCERAL SURGERY
In terms of frequency, the most frequently treated pathologies are:
- emergency: appendicitis, peritonitis, occlusion, stangulated hernia, abdominal traumas, digestive hemorrhages (gastro-duodenal ulcer, hemorrhoids…)
- non-emergency: gall bladder, hernias and eventrations, colic diseases: Crohn’s and ulcerative colitis, tumors, gastric pathologies: gastroesophageal reflux disease (GERD), ulcers, tumors, pathologies of the small intestine, the pancreas, the spleen…
Surgical treatment of abdominal hernias
A hernia is the exit or protrusion of an organ, most often the small intestine, through a natural orifice of the abdominal wall. The slide of the small intestine only occurs during effort or in a prolonged standing position. When one lies down, it spontaneously returns to the abdominal cavity, where it can also be made to return with the motion of a hand. The term “inguinal hernia” is used when the hernia is located just above the crease of the groin; the terms “crural hernia” or “femoral hernia” are used when it is located under the crease of the groin; finally, an “umbilical hernia” is located at the level of the navel.
Gall bladder removal operation (or cholecystectomy by coeloscopy)
The gall bladder is an organ located in a shallow cavity under the liver, which is itself located in the right section of the abdomen. It is appended to the bile duct, which is the duct that goes from the liver to the intestine and transports the bile secreted by the liver.
HEPATIC SURGERY
First liver biopsies by the team at the Poitiers CHU’s.
ENDOCRINE SURGERY
A reference center at the regional and nationwide level in the field of endocrine surgery, the CHU department is first and foremost devoted to thyroid operations.
From the neighboring Indre, Charentes and Deux-Sèvres departments, patients gravitate, as it were, towards the visceral and endocrine surgery unit of the Poitiers CHU, a reference center drawing untold benefit from its prolonged experience and with its cutting-edge techniques.
While the department undertakes surgery of the parathyroid, adrenal and pancreas glands, thyroid accounts for the largest proportion of its activity; more than 600 cases are treated each year.
There are several different reasons for this operation: appearance of a nodular goiter whose volume can cause compression of neighboring organs, hormonal imbalance causing hyperthyroidism, and either prevention or treatment of thyroid cancer, which most often presents in the form of a nodule.
Thyroid cancer screening
From the age of 50 onward, more than half of the population develops thyroid nodules. This pathology, to which women are particularly susceptible, is malignant in only 10 to 15% of cases, and it is not always easy for an attending physician to screen the nodules presenting a risk of cancer. That said, a practitioner may receive some clues by palpating the zone to be monitored. To better establish a diagnosis, it is possible to prescribe four main examinations:
Ultrasound scan is the most effective way of proceeding to morphological analysis of the gland. Findings such as the presence of microcalcifications and the regularity or irregularity of the nodule are criteria for screening a malignancy.
The doppler renders the ultrasound even more precise, particularly in visualization of hypervascularization. If the latter is peripheral, the nodules are likely to be benign; if it is central, they may be malignant. Most often, only an intervention permitting histological analysis provides confirmation of a malignancy.
Following thyroid intervention, it is well-advised to massage the scar. See the explanatory video (in French) below.
Surgical procedure
After study of the all the aforementioned clinical, biological and, particularly, echographic criteria, it is possible to establish an indication for surgery. This is not a cumbersome or “heavy” intervention, but rather a meticulous operation in which the surgeon’s expertise is preponderant, and duration of hospital stay generally ranges from just 2 to 3 days. The surgeon must take care to conserve the “noble” elements adjoined to the thyroid gland to be removed. More specifically, the recurrent nerves and the parathyroid glands require protection. The recurrent nerves correspond to the motor nerves of the vocal cords and pass behind the gland to which they are closely adjoined. When they are traumatized, vocal and at times respiratory disorders ensue. Following the operation, control of vocal cord mobility is systematic.
Comparable in size to a grain of rice, the four parathyroid glands control calcium levels on the blood and need to be identified and conserved. When they are traumatized, hypocalcemia ensues, and compensation is necessary.
In most cases, these phenomena are only transitory. For example, the operation often entails a benign inflammatory reaction due to suture resorption. This type of “neck swelling” is in no case a hematoma. Over the seven or eight weeks following the operation, it is necessary that in the affected area, the patient undergo massaging with topical corticosteroids. In some difficult cases, particularly cancers, a postoperative evaluation is necessary. The endocrine surgery unit conducts expert appraisal in close collaboration with the endocrinologists and nuclear physicians of the Poitiers CHU in multidisciplinary meetings during which decisions on therapeutic strategies are reached on a case-by-case basis.