The gallbladder is a small pouch located at the inferior face of the liver, which is responsible for stocking bile between meals. When food enters the stomach and duodenum, the gallbladder contracts and about 100mL of bile is excreted in the bowel, primarily for helping to digest fat. Up to 20% of people have gallstones which can produce symptoms, such as repeated abdominal colicky pain, inflammation ofthe gallbladder (cholecystitis), and inflammation of the pancreas (pancreatitis) or the main bile ducts (cholangitis).
Gallstones, when they are responsible of symptoms, are an indication for surgery. The operation consists of removing the gallbladder (laparoscopic cholecystectomy) and the stones, through a minimally invasive technique with 4 incisions of 5-10 mm. The procedure takes about 1 hour to perform and the patients usually stay in the Clinic for one night.
Gastroesophageal reflux surgery
Gastroesophageal reflux (GERD) is a common problem, which affects 20% of the adult population. Once the diagnosis is established by the gastroenterologist, lifestyle modifications (weight loss) and medical treatment (proton pump inhibitors PPIs, such as omeprazole) with endoscopy and biopsies) is introduced. For those patients who fail to respond to this conservative approach, who have side-effects of PPIs, or who present with large hiatal hernias, the indication for surgery should be discussed by a multidisciplinary team and individualized according to the patients’ symptoms, co-morbidities and age.
The best surgical option in thin patients is a laparoscopic Nissen fundoplication, which consists in wrapping the upper part of the stomach around the lower esophagus. Laparoscopic gastric bypass is the procedure of choice when morbid obesity and GERD coexist. Both procedures are performed with a minimally-invasive approach using 4-5 small (1cm) incisions, and require a 3-4 days hospital stay.
According to the Swiss Society for the Study of Morbid Obesity (SMOB), patients are candidates to weight loss surgery if they; 1) have a BMI <35, and 2) have previously tried (and failed) to lose weight by a conservative approach (low calories diet) under medical surveillance. Weight loss surgery offers the obese patients an opportunity to lose 2/3 of their excess weight, but may also cure associated diseases, such as diabetes and sleep apnea.
Dr. Gervaz holds a Master (3rd cycle University Degree DIU) in bariatric surgery and performs sleeve gastrectomies and gastric bypasses, the two most common procedures for morbid obesity. Both procedures are performed with a minimally-invasive approach using 4-5 small (1cm) incisions, and require a 3-4 days hospital stay.
Colorectal cancer surgery
Colorectal cancer remains the third cause of death by cancer, despite a declining incidence in relation with the detection of early lesions (polyps) by screening with colonoscopy. However, a significant number of patients, sometimes younger than 50, initially presents with metastatic disease to the liver and/or the lung.
Surgery is the cornerstone of treatment. Segmental colectomy (right or left, according to tumor location) are performed with a very low mortality (<1%) but a relatively high rate of infectious complications (10-20%). These procedures are performed in 50% of cases by a minimally invasive (laparoscopic) approach, take about 2-3 hours to perform and require a 4-6 days hospital stay. Postoperative chemotherapy may be indicated according to tumor stage and lymph node invasion by cancer cells. Rectal cancer surgery is more complex, with significant functional problems and represent a highly specialized field of surgery according to Swiss Health authorities.
Dr. Gervaz has performed more than 2,500 resections of the colon and rectum during his career, and received formal training in Colon & Rectal Surgery during 3 years at Cleveland Clinic and Mayo Clinic.
Diverticulitis and diverticular disease
More than 50% of individuals aged >60 have diverticula usually located on the sigmoid colon, yet the vast majority have no or minimal symptoms. Bleeding and pain in the lower left part of the abdomen (diverticulitis) may occur and require medical evaluation with CTscan and colonoscopy to establish the diagnosis and assess disease location and severity. Non-complicated diverticulitis is treated with oral antibiotics, while complicated (abscess, peritonitis) diverticulitis is a more severe presentation which justifies inpatient management with intravenous antibiotics, drainage and/or emergency surgery.
Simple uncomplicated episodes of diverticulitis may recur and patients who experienced 3 or more attacks of uncomplicated diverticulitis are candidates for surgery. The procedure is a laparoscopic sigmoid resection, which is performed with 4-5 small skin incisions (5-10mm), takes 2-3 to perform, and requires 4-5 days of hospital stay.
Diseases of the anus and anal canal are quite common in individuals of all ages. Hemorrhoids, fissures and abscesses may cause significant pain, bleeding and discomfort. A gentle but thorough clinical examination by a specialist is mandatory to make a diagnosis (in most cases a benign process with good prognosis) and exclude life-threatening conditions, such as anorectal cancer and perineal sepsis.
Peri-anal abscesses require emergency surgery to evacuate the pus and drainage of the residual cavity. Fissures are treated with laxatives and pommades/suppositories in most cases. Prolapsed hemorrhoids with severe symptoms (repeated bleeding over long periods of time) are an indication for surgery. Resection of hemorrhoids (Milligan-Morgan procedure) provides cure from the disease and its symptoms; surgery is performed under general anesthesia, takes less than one hour, and usually requires 7-10 days sick leave.
Hernias of the abdominal wall
A hernia is a protrusion of the abdominal content through a weak spot of the abdominal wall. Most hernias are located in the inguinal and the umbilical areas and present as a bulge in the groin or the bellybutton. Hernias can cause significant discomfort, and in a minority of cases can lead to complications such as bowel occlusion. It is a mechanical problem more than a disease, and there is no therapeutic alternative to surgery.
Surgical treatment is curative, and nowadays performed with mesh placement. When inguinal hernia is unilateral, we perform open surgery with tension-free reinforcement of the inguinal floor (Lichtenstein repair). Bilateral inguinal hernias are best treated with laparoscopic repair with 3 small incisions and extra-peritoneal mesh placement (TEPP repair). Umbilical hernias are treated with a small 3cm incision around the umbilicus. All procedures require general or peridural anesthesia, and can be performed during an ambulatory (outpatient) or short (1 night) hospital stay according to patients’ age, social status and co-morbidities.