INNOVATIVE PROCEDURES

POEM – TREATMENT OF ACHALASIA
POEM/Per-Oral Endoscopic Myotomy

The “POEM” procedure allows for the treatment of any dysphagia or swallowing disorder caused by esophageal dysfunctions such as achalasia.

This technique attempts to separate circular muscular fibers from the bottom of the esophagus while preserving the outer and inner walls using a transoral revolutionary approach without skin incision.

It is essential to remember that no surgical procedure is able to cure achalasia; the division of these muscles allows to improve patients’ swallowing problems and quality of life.

POEM – TREATMENT OF ACHALASIAphoto credit © WeBSurg.com


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DIGESTIVE SURGERY – MORBID OBESITY
Bariatric surgery: surgical techniques

The surgical management of obesity relies on 4 axes to achieve the best outcomes:

  • surgical procedure,
  • nutritional management, both preoperatively and postoperatively,
  • preoperative, and sometimes postoperative, psychological evaluation and follow-up,
  • regular and sustained physical activity according to patient’s physical abilities.

Indeed, the surgical intervention alone only allows for average and short-term outcomes if the other axes are neglected.

Consequently, the patient is offered a multimodal preoperative course. After having set up dietary, psychological and behavioral managements, a preoperative work-up is performed.

It is intended to minimize medical risks related to a surgical procedure, and to anticipate possible contraindications for certain surgical techniques.

The type of procedure is decided upon at the end of the preoperative work-up, which allows for the detection of any contraindications to certain types of procedures.

Five operative techniques can be performed according to the needs, benefits and risks related to morbid obesity surgery:

  • Gastric banding or gastroplasty
  • Longitudinal gastrectomy (sleeve)
  • Gastric bypass
  • Mini-gastric bypass
  • Biliopancreatic diversion
  • Endo-Sleeve 

ENHANCED RECOVERY AFTER SURGERY – ERAS

ERAS® is a new concept for the patient management for improving postoperative recovery.

While the dogma in digestive surgery is to submit the body to complete rest before and after surgery, the ERAS® concept proposes maintaining a minimal metabolic activity and to quickly remobilizing the digestive system after surgery.

Several studies have shown that such management allows faster functional recovery, earlier mobility and reduced postoperative complications. It reduces both physical and mental surgery-related stress. The ERAS® concept is patient-centered and aims to facilitate patient management. Finally, it shortens the length of postoperative stay, improving the patient’s quality of life and optimizing costs.

This concept, originally developed in Scandinavia, represents a major advance in the management of patients undergoing digestive surgery. Many countries have already adopted this concept and it is being implemented progressively in France.

TRANSANAL ENDOSCOPIC SURGERY – TEM – PROGRESS

Surgical management of colorectal polyps and tumors may require complete or partial removal of the rectum. In general, this technique is performed either by open surgery or by minimally invasive surgery through the abdominal wall.

The medical and surgical team of the Institute now offers a scarless approach which consists in removing cancerous tissues transanally.

These approaches, called TEM (Transanal Endoscopic Microsurgery) and PROGRESS (Peri Rectal Oncologic Gateway for Retroperitoneal EndoScopic Surgery), allow significantly reduced postoperative complications and length of hospital stay.

PERSONALIZED AND COMPUTER-ASSISTED SURGERY OF THE LIVER

Surgical management of tumors in the liver (metastasis, hepatocellular carcinoma, etc.) requires partial removal of the liver to remove cancerous foci.

This surgery requires careful preparation and high accuracy in order to preserve as much healthy tissue as possible and to avoid damaging major blood vessels.

To do so, the surgical teams of the Institute use a 3D imaging reconstruction for each patient, which is created from scanner or MRI diagnostic data. These models allow surgeons to preoperatively define the best strategy and, intraoperatively, to guide the surgeon in real time with augmented reality.

MINIMALLY INVASIVE TREATMENTS BY INTERVENTIONAL ENDOSCOPY

An increasing number of surgical procedures generally performed by open or minimally invasive surgery are now performed by interventional endoscopy.

This approach uses a flexible endoscope to operate directly within the digestive tract and allows for the targeting of very small areas.

The endoscopic approach is generally used for the surgical management of esophageal cancers associated with an early diagnosis. The procedure consists in removing the part of the esophagus where the tumor is located.

The surgeon removes cancerous tissue(s) from the esophageal mucosa (submucosal resection, complete resection or “full-thickness”). Endoscopic intervention avoids removal of an entire section of the organ, a major procedure which requires a long hospital stay and presents several postoperative complications.

Interventional endoscopy is routinely performed by the medical and surgical team of the Institute. It is used for many other procedures such as stomach and some colorectal tumors.

NATURAL ORIFICE TRANSLUMINAL ENDOSCOPIC SURGERY – NOTES

New endoscopic techniques have allowed for the development of a scarless surgery for several surgical procedures, such as the removal of the gallbladder (cholecystectomy) or bariatric surgery.

The NOTES (Natural Orifice Transluminal Endoscopic Surgery) technique involves introducing a flexible endoscope using the esophageal, vaginal or rectal approach in order to reach the procedure area, avoiding incisions through the abdominal wall.

The absence of incision in the abdominal wall (skin, muscle) reduces postoperative pains and facilitates recovery, in addition to the aesthetic aspect of non-visible scar.

Since the first NOTES procedure performed on a patient for the removal of gallbladder in 2007, the medical and surgical team of the Institute has pioneered the development of this technique for numerous digestive and abdominal operations.

For more information, please do not hesitate to contact us at the following email address:
patients@ihu-strasbourg.eu