Digestive surgery
Digestive surgery represents a fascinating and vital area of modern medicine, encompassing a range of surgical procedures that target diseases affecting the gastrointestinal tract and associated organs such as the esophagus, stomach, small and large intestines , rectum, liver, gallbladder and pancreas . With advances in medical technology and advances in surgical techniques, specialists in this sector are able to offer less invasive and more precise treatments , significantly improving patient outcomes.
The gallbladder
The gallbladder, this compact, pear-like organ, plays a crucial role in storing bile, nestling beneath the liver. It serves as a reservoir for bile outside periods of digestion. When ingesting foods high in fat, it becomes activated, releasing its fluid into the duodenum to aid digestion.
Nearly one in five people develop gallstones , which can cause a range of symptoms from sporadic pain to serious complications such as inflammation of the gallbladder or infection of the bile ducts and pancreas. The presence of gallstone-related symptoms usually indicates the need for surgery. The preferred technique is laparoscopic cholecystectomy , a minimally invasive method, requiring four small incisions of 5 to 10 mm. This procedure, which generally lasts one hour, allows patients to have a brief stay in the clinic, often no more than 24 hours.
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Gastroesophageal reflux
Gastroesophageal reflux disease (GERD) affects approximately one-fifth of adults. The diagnosis is established using an upper digestive endoscopy. Initially, patients consult a gastroenterologist, who usually prescribes highly effective treatments, such as proton pump inhibitors (PPIs, e.g. omeprazole). Surgery is considered for cases where the RGE does not respond to medications, for patients suffering from adverse effects related to PPIs, or in the presence of a large hiatal hernia that causes mechanical discomfort due to compression.The procedure of choice to counter reflux is Nissen fundoplication, which involves forming a gastric valve around the lower section of the intra-abdominal esophagus. For cases where GERD is accompanied by marked obesity, gastric bypass is preferable. These procedures are performed laparoscopically, requiring 4 to 5 small incisions (5 to 10 mm) and a hospital stay of 3 to 4 days is usually required.
Obesity surgery
According to the guidelines of the Swiss Society for the Study of Obesity (SMOB), bariatric surgery is recommended for obese individuals with a Body Mass Index (BMI) greater than 35 who have previously followed a diet supervised by a nutritionist , without success. Despite initial controversies, this surgery has gained recognition for its safety and effectiveness, largely due to the laparoscopic technique which simplifies post-operative recovery.
Dr. Gervaz, with his 3rd Cycle Master's degree specialized in bariatric surgery, offers patients the option of a sleeve gastrectomy or gastric bypass. These two surgical methods, comparable in terms of effectiveness, play a significant role in the improvement or resolution of related disorders such as diabetes or sleep apnea. Performed laparoscopically with 4 to 5 1 cm incisions, these procedures require a clinical stay of 3 to 4 days.
Colorectal cancer
Colorectal cancer is among the leading causes of cancer-related mortality, ranking third. Fortunately, in Western countries its incidence is declining, in part due to early detection via colonoscopy. However, there is still a significant number of patients in whom the initial diagnosis reveals colorectal cancer that has already metastasized to the liver or lungs.
Surgery is essential in the treatment of colon cancers. The initial surgical strategy includes segmental colectomies—right or left, depending on the location of the tumor. These moderately complex operations present a very low mortality risk (less than 1%) but are associated with a notable rate of infectious complications (between 10% and 20%). They can be performed laparoscopically or via a traditional open surgical approach and usually require a clinical stay of 4 to 6 days. Adjuvant chemotherapy may be prescribed if regional lymph node involvement is noted. Surgical treatment of rectal cancer is more complex and often involves preoperative radiotherapy and may require the temporary or permanent establishment of a stoma.
Dr. Gervaz, with a three-year specialization in colorectal surgery acquired in two renowned clinics in the United States — the Cleveland Clinic and the Mayo Clinic, has to his credit more than 2,500 procedures on the large intestine. His contributions to this medical field have been recognized in distinguished scientific publications.
Diverticulitis and diverticular disease
The presence of diverticula in the sigmoid colon is a common condition, affecting more than half of people over the age of 60. Most of the time, these diverticula remain asymptomatic. When diverticular disease becomes symptomatic, it may present with bleeding or painful episodes in the lower abdomen, known as diverticulitis. In these cases, radiological examinations such as CT scan or endoscopic investigations such as colonoscopy are necessary to make an accurate diagnosis, assess the severity of the disease and eliminate the hypothesis of colorectal cancer.
For uncomplicated diverticulitis, the treatment of choice is usually a regimen of oral antibiotics, often administered on an outpatient basis without the need for hospitalization. On the other hand, cases of complicated diverticulosis, characterized by complications such as abscesses, perforations or peritonitis, require more intensive care. This severe form of the disease requires hospitalization, administration of intravenous antibiotics, and sometimes drainage or urgent surgery.
Recurrences of simple diverticulitis are possible and, after three episodes, the patient may be considered for surgery. Laparoscopic sigmoidectomy is the standard treatment in these cases, a procedure performed through 4 to 5 small incisions of 5 to 10 mm. This surgery, which lasts between two and three hours, is followed by a postoperative stay in the clinic of four to six days.
Proctology
Disorders affecting the anus and lower rectum are common at all ages. Among these conditions, hemorrhoidal diseases, anal fissures and abscesses are the main culprits for unpleasant symptoms like bleeding, pain and itching. A thorough clinical examination, carried out by an experienced specialist in optimal conditions of comfort for the patient, constitutes the cornerstone of the diagnosis.
Perianal abscesses require immediate surgery to drain the pus and place a drain, thus avoiding complications. For fissures and simple cases of hemorrhoids, treatment is mainly based on the application of topical creams and/or the use of suppositories, accompanied by laxatives to alleviate constipation. Hemorrhoids causing more severe symptoms, such as prolapse or persistent bleeding, require surgery. Hemorrhoidal resection, known as the Milligan-Morgan operation, is performed under general or epidural anesthesia and involves a brief hospital stay of 24 hours and a convalescence of 7 to 10 days.
Une hernie se manifeste par la saillie du contenu abdominal à travers une zone affaiblie de la paroi abdominale, souvent située dans les régions inguinale ou ombilicale, formant une bosse au niveau de l'aine ou autour du nombril. Ces hernies peuvent entraîner un inconfort ou des douleurs lors de certains mouvements et risquent de s'aggraver en provoquant une incarcération intestinale. Face à ce problème de nature mécanique, la chirurgie représente l'unique solution thérapeutique viable.
Surgical treatment of hernias involves strengthening the abdominal wall using synthetic prostheses. For simple (unilateral) inguinal hernias, open surgery is preferred using the Lichtenstein technique, which consists of an incision of approximately 5 cm in the groin fold. More complex inguinal hernias, such as bilateral or recurrent cases, are usually treated laparoscopically, requiring three small incisions of 5 to 10 mm (TEPP technique). Umbilical hernias are repaired via a traditional surgical approach, with an incision of approximately 3 cm around the navel. These procedures require general or epidural anesthesia and can result in work stoppage for several weeks, particularly for people in physical occupations. Depending on the age, social condition and state of health of the patient, these operations can be carried out on an outpatient basis.