Expert & Leader of department: Dr. med. Dipl. oec. med. Colin M. Krüger
The field of visceral surgery comprises the complete surgery of the alimentary tract, from the gullet to the rectum, emphasizing the tumor surgery and chronic inflammatory bowel diseases, the surgery of endocrine organs (thyroid, parathyroid and suprarenal gland), the surgery of liver, gall bladder and bile duct, pancreas and splenic, as well as the soft parts surgery, to which also belong the surgery of hernia inguinalis and incisional hernia, surgeries at the female breast and surgeries of tumor and inflammatory processes of the body surface or of soft parts inside the body.
Qualification and Further Education
The competent representatives of this surgical discipline are the experts for visceral surgery in the field of surgery. Visceral surgeons are sub-specialized general surgery specialists with multiple years of additional training in the field of special visceral surgery, which takes place following a predetermined curriculum and which will be concluded in front of the responsible further education committee of the medical council with an individual specialist examination.
A priority of the visceral surgery is the tumor surgery of the gastro-intestinal system. The goal in doing this is apart from the removal of the tumor the functional integrity and a high quality of life after the operation. Through new techniques (surgical stapling instruments, ultrasonic surgical knives) and the creation of organ substitutes (small intestine and colon pouch) the construction of an artificial anus for instance is preventable in the case of cancer of the large intestine or rectum cancer. Based on the modern anesthesiologic and intensive therapeutic possibilities complex surgical methods (for instance the partly removal of liver or lungs in case of subsidiary abscesses) are also included in the standard repertoire in the treatment of cancer diseases. Already before and especially after the operative treatment an individual treatment concept for each patient is defined in cooperation with other clinics (oncology, radiation therapy, pathology, pain clinic, (home) care) in a special oncology working group, so-called tumor-boards with a common oncology emphasis. This intensive interdisciplinary team work ensures an optimized and individualized therapy concept for the patient following state-of-the-art scientific insights.
Minimally Invasive Surgery (MIC) In the surgery of benign diseases it is possible to perform an increasing part of the operations with the minimally invasive surgery technique, better called "video-endoscopic surgery". This procedure for the removal of the gall bladder is established for years. Even hernia inguinalis surgeries, the removal of the appendix or of parts of the large intestine with inflammations (sigmoid diverticulitis), surgeries due to a severe reflux (pyrosis) as well as the removal of affected suprarenal gland can be performed in this way. The advantage of this operating technique lies in the need of only smallest incisions. Due to that reason the pain after the operation is minor, the healing process faster and the duration of a necessary stay in the hospital shorter. Another critical advantage of the minimally invasive surgery is, aside from the cosmetic aspect, that through the mostly preservation of the integrity of the abdominal wall, respectively the skin surface, the post-operative mobilization and respiratory mechanics are significantly less affected. Resulting explanations are the mostly quicker post-operative mobilization and a smaller need of pain medication.
Another important part plays the MIC in the tumor surgery. During its course it can be first of all examined minimally invasive previous to major operations with wide openings of body cavities, if the removal of the tumor is possible surgically. Consequently, in the interest of the patient the extent of the operation can be individually adjusted and if applicable alternative treatments of tumor diseases (chemotherapy / radiation) timely initiated.
Currently, following operations with the minimally invasive technique are performed in numerous clinics in Germany and internationally:
Laparoscopic cholecystectomy (removal of gall bladder)
Lap. appendectomy ( removal of appendix)
Lap. hernia repair (TEP, TAPP)
Lap. repair of incisional hernias (IPOM)
Lap. fundoplication (reconstruction of upper pylorus)
Lap gastric banding
Lap. gastric bypass
Lap. suturing procedure for the stomach
Lap. adrenalectomy (removal of adrenals)
Lap. splenectomy (spleen removal)
Lap. adhesiolysis (detachment of accretion in the abdomen)
Lap. exploration of gastric cancer
Lap. exploration of pancreas/ pancreatic carcinoma
Lap. treatment of parastomal hernia
Lap. reparations of diaphragmatic rupture (phrenic)
Lap. hemicolectomy right / left
Lap. sigma resection
Lap. rectal resection
Lap. ostomy (artificial anus)