Upper Gastro-intestinal surgery

All oesophageal and gastric surgery, for both benign and malignant disease, and including laparoscopic techniques where appropriate.

Oesophageal cancer

  • diagnosed at endoscopy (upper gastro-intestinal endoscopy, also known as gastroscopy ).
  • workup will typically include: CT scan, PET scan, with laparoscopy employed for tumours in the mid and lower oesophagus.
  • tumours that have not begun to invade the oesophageal wall may be treated using endoscopic techniques.
  • early invasive tumours will generally go straight to surgery.
  • other invasive tumours will generally require pre-operative chemotherapy, or chemotherapy and radiotherapy combined.
  • if the tumour has spread, then surgery to remove the oesophagus is not indicated, and chemotherapy or chemotherapy and radiotherapy are the main treatments offered, along with an oesophageal stent for those with severe swallowing difficulty.

Gastric (stomach) cancer

Hiatus hernia

  • there are two types, the rolling or para-oesophageal type, and the sliding type.
  • rolling hernias present a risk of strangulation, and generally do require surgery, even if asymptomatic.
  • sliding hernias are associated with GORD, but not all patients with severe GORD have a hernia, and not all patients with a hernia have GORD.
  • hiatal hernias, when present, are always repaired when performing surgery for GORD.

Reflux disease (GORD)

  • reflux is common in our society.
  • most patients can be managed with medication, but some do require surgery.
  • pre-disposing “lifestyle” factors are: overweight, smoking, alcohol, and caffeine.
  • most operations are done as keyhole/laparoscopic surgery.
  • surgery involves repairing a hiatal hernia and tightening the opening for the oesophagus, and then wrapping the upper part of the stomach around the junction of oesophagus and stomach (this is known as a fundoplication, and it helps create a type of one-way valve).


  • this is a disorder of the muscle of the oesophagus, and it causes difficulty with swallowing.
  • the most common treatment is a keyhole/laparoscopic operation known as a Heller’s myotomy, which divides the over-active muscle at the lower end of the oesophagus.