Upper gastrointestinal surgery: Current trends and recent innovations

Abstract

Upper gastrointestinal surgery has witnessed an enormous leap in the last decade, largely related to introduction of new technologies; with the advent of NOTES and the advancement of robotic surgery and various endoscopic techniques, many of the now standard laparoscopic procedures are now being attempted through these approaches. It seems as this is a turnover of a new generation of surgical techniques which may once more change the face of surgical practice and values, just as laparoscopy did in the last two decades. Another focus of interest is Barrett's esophagus, which has been one of the most studied upper gastrointestinal diseases in recent research studies owing to its identified risk of cancer development; making it one of few possible targets of cancer prevention. Recently, the massive increase in rate of performance of bariatric surgeries has put these techniques in the focus of comprehensive research in terms of technical perfection as well as metabolic and physiological consequences. As for other benign and malignant esophageal and gastric conditions, various studies have addressed both the surgical technical, and more importantly, the biological question of etiology, diagnosis and follow up. In spite of the achievements in the field, it is still open for vast future progress whether on the basic science frontier or on the clinical training and practice grounds. Upper Gastrointestinal surgery has been an area of prolific development in recent decades. The introduction of obesity and metabolic operations has seen a dramatic expansion in view of the worldwide pandemic of obesity. Novel treatment therapies include the introduction of Natural Orifice Transluminal Endoscopic Surgery (NOTES), Endoluminal therapy, Endoscopic Mucosal Resection (EMR) and Photodynamic Therapy. There has been increased clarification of the mechanisms of Gastro-Esophageal Reflux Disease, Achalasia, Barrett's Esophagus and Esophageal Cancer. This includes disease progression and the use of tumour markers, molecular profiling, detection of micrometastases and diagnostic laparoscopic/thoracoscopic techniques. Other developments include an increased appreciation of surgical skills training and volume-outcome relationships. © Springer-Verlag Berlin Heidelberg 2010.