2. General objective
At the end of the class the students will be able to get
through knowledge about clinical and physiotherapy
aspect of upper GIT surgeries
To know meaning of different surgeries
To know incision sites
To know complication of surgeries
To know post operative PT management
6. Upper Gastrointestinal surgeries include the
surgical management of patients with disorders
of the oesophagus, stomach, duodenum, small
bowel, pancreas, liver and biliary tree.
Peptic ulcer disease
Tumours, benign and malignant of the upper
Strictures of the upper GI tract
Foreign bodies in the GI tract
Bleeding of the upper GI tract
7. Surgical procedures
Small bowel enteroscopy
Laparoscopic surgery of the upper GI tract
Open surgery of the upper GI tract
Pancreaticoduodenectomy (Whipple procedure)
Endoscopy is a nonsurgical procedure used to
examine a person's digestive tract. Using an
endoscope, a flexible tube with a light and camera
attached to it pictures of digestive tract can be seen
on a color TV monitor.
Endoscopes can be passed into the large intestine
(colon) through the rectum to examine this area of the
intestine. This procedure is called sigmoidoscopy or
colonoscopy depending on how far up the colon is
ENDOSCOPIC ULTRASOUND or EUS combines
upper endoscopy and ultrasound examination to
obtain images and information about various parts of
the digestive tract
Ulcers, gastritis, or difficulty swallowing
Digestive tract bleeding
Changes in bowel habits (chronic constipation or diarrhea)
Polyps or growths in the colon
In addition, endoscope is also used to take a biopsy to
look for the presence of disease.
Endoscopy may also be used to treat a digestive tract
problem. For example, the endoscope might not only
detect active bleeding from an ulcer, but devices can
be passed through the endoscope that can stop the
10. SMALL BOWEL ENTEROSCOPY
A small bowel enteroscopy is used to view the entire
small bowel from either an oral or rectal approach, to
perform both diagnostic and therapeutic techniques
within the small bowel without the need of an open
A special endoscope that, when inflated with air, can
expand sections of the small intestine to enable the
camera to get a closer view.
Small intestinal bleeding
Obscure gastrointestinal bleeding
Iron deficiency anemia
Failed GI endoscopies.
11. LAPROSCOPIC SURGERIES OF UPPER GIT
Laparoscopic surgery, also called minimally invasive surgery,
bandaid surgery, or keyhole surgery, is a modern surgical technique
in which operations in the abdomen are performed through
small incisions (usually 0.5–1.5 cm) as opposed to the larger
incisions needed in laparotomy
Keyhole surgery makes use of images displayed on TV monitors to
magnify the surgical elements.
The key element in laparoscopic surgery is the use of a laparoscope.
There are two types:
(1) a telescopic rod lens system, that is usually connected to a video
(2) a digital laparoscope where the charge-coupled device is placed at
the end of the laparoscope, eliminating the rod lens system, inserted
through a 5 mm or 10 mm cannula or trocar to view the operative
The abdomen is usually insufflated, or essentially blown up like a
balloon, with carbon dioxide gas. This elevates the abdominal wall
above the internal organs like a dome to create a working and
viewing space. CO2 is used because it is common to the human body
and can be absorbed by tissue and removed by the respiratory
system. It is also non-flammable, which is important because
electrosurgical devices are commonly used in laparoscopic
12. Laparoscopic cholecystectomy (removal of gall
bladder) is the most common laparoscopic
shortens recovery time
less post-operative scarring.
less pain medication needed.
Short hospital stay
Reduced exposure of internal organs
Reduced risk of acquiring infections.
An esophagectomy is surgery to remove part or
all of the esophagus, the tube that moves food
from your throat to your stomach. After it is
removed, the esophagus is rebuilt from part of
your stomach or part of your large intestine.
Most of the time, esophagectomy is done to
treat cancer of the esophagus.
Transhiatal esophagectomy is
the neck and abdomen simultaneously
Transthoracic esophagectomy involves
opening the thorax
Gastrectomy is surgery to remove part
or all of the stomach.
If only part of the stomach is removed, it
is called partial gastrectomy
If the whole stomach is removed, it is
called total gastrectomy
Depending on what part of the stomach
is removed, the intestine may need to be
re-connected to the remaining stomach
(partial gastrectomy) or to the
esophagus (total gastrectomy)
Non-cancerous (benign) tumors
16. PANCREATIC DUODENECTOMY
Pancreaticoduodenectomy is also called
Whipple procedure. It is done to remove
a tumor from the pancreas or bile duct. A
pancreatic or bile duct tumor forms when
cells become cancer.
During the Whipple procedure, the
gallbladder, duodenum, bile duct, and
head of the pancreas may be removed.
Sometimes, the pylorus and lymph nodes
may also be taken out. Enough of the
pancreas is left to produce digestive
juices and insulin.
The small intestine will be attached to
the stomach and to the remaining bile
duct and pancreas.
Incision used is upper midline and upper
bilateral costal margins.
Hepatectomy consist of the
surgical resection of the liver.
Hepatic neoplasms, both benign or
Intrahepatic gallstones or parasitic
cysts of the liver
Partial Hepatectomies are also
performed to remove a portion of a
liver from a live donor for
18. PT MANAGEMENT
Pre op notes should be read carefully, relevant
Assess respiratory expansion and teach
diaphragmatic and lateral costal breathing.
Proper coughing technique should be taught
Foot and leg exercises should be taught and told
why they are important
19. POST OPERATIVE MANAGEMENT
Surgical notes must be read with nursing record
of patients condition
Position of drainage tubes, iv lines, catheter and
type of dressing should be noted
Therapist should arrange that analgesic are
given before PT treatment.
Site and type of incision should be noted.
Trachea must be kept patent to avoid obstruction
until the patient is unconscious
Respiratory condition should be assessed.
Prevention of chest complications
Prevention of thrombosis
Prevention of pressure sores
Pain management ( Incisional pain )
Prevention of muscle wasting and joint
21. Post op day1
Patient will be more alert & have good pain
control, ask the patient to sit out of bed for
shorter period of time.
Early mobilization should be started to reduces
chances of respiratory complication.
Planter/dorsi flexion every 15 min.
Deep breathing exercises
Coughing with splinting
22. Post op day2
Make the patient ambulate for short distances
Continue day one exe.
Commence pelvic rocking
Incentive spirometry will be useful to encourage
patient to continue breathing exercise between
23. Post op day3
All drains may be removed, so patient’s level of
activity can be increased.
Longer periods of sitting & walking can be
Abdominal drawing in may be commenced as
sutures are removed.
Continue day one exercises
If incisional pain is there - Application of
TENS can be given.
24. At home
Start walking for 5-10 mins to build up stamina
Start up and down stairs
Start doing ADLs
Increase walking time and distance each week
25. RESPIRATORY PHYSIOTHERAPY TO PREVENT
PULMONARY COMPLICATIONS AFTER ABDOMINAL
SURGERY* : A SYSTEMATIC REVIEW
P- Post operative Pulmonary complication
I- Respiratory Physiotherapy
C- No physiotherapy
O- Incidence of pulmonary complications
26. CHEST 2006;130;1887-1899
for articles in
included if they
outcomes, and if
was at least 2
13 trials with a
control group, 9
studies did not
in 1 study, the
in 1 study, the
in 1 study, the
There are few
27. PREVENTION OF RESPIRATORY COMPLICATIONS
AFTER ABDOMINAL SURGERY
P- A patient with abdominal surgery
I – Prophylactic respiratory physiotherapy
C- Different techniques of respiratory
physiotherapy or no therapy
O- Prevention of respiratory complication
28. THORAX 1997;52(SUPPL 3):S35–S40
than 60 years
of age low
ns was 15%
surgery is deep