Upper Gastro Intestinal Surgery

The Upper Gastro-Intestinal (UGI) unit at UMMC manages a variety of complex diseases of the oesophagus and stomach. We focus on cancers of the oesophagus and stomach, functional swallowing and eating disorders, as well as bariatric and metabolic procedures. The majority of the procedures performed are minimally invasive in nature, either via laparoscopy (key hole surgery) or endoscopically (via natural orifices), leading to smaller scars, less pain, and quicker recovery times.

Malignant UGI Diseases

We practice a multi-disciplinary approach to all UGI malignancies, involving oncologists, sports medicine physicians, and dietitians. As most UGI cancer surgeries are complicated and prolonged, the sports medicine physicians and dietitians work to ensure a patient is fit enough to undergo the procedure. Working in tandem with our gastroenterologists, we also offer endoscopic resections of early-stage cancers. These procedures gain access via natural orifices (the mouth), and are completely scarless. The following malignant processes are treated at our centre:

1. Oesophageal cancer
2. Stomach cancer
3. Gastro-intestinal Stromal Tumours (GISTs)
4. Small Intestine cancer

Benign UGI Diseases

A variety of swallowing disorders are treated at our centre. We are the only public hospital in Malaysia that performs Per-Oral Endoscopic Myotomies (POEM), a treatment for Achalasia Cardia (a swallowing disorder) that utilizes an endoscopic approach, thus is scarless. The following are examples of benign UGI diseases that are treated at our centre:

1. Achalasia Cardia
2. Hiatal hernias
3. Gastro-Oesophageal Reflux Disease (GORD)
4. Benign oesophageal strictures

Bariatric and Metabolic Surgery

So-called “weight loss surgery” has been associated with some social stigma, but has now gained acceptance as a valuable treatment option for patients with metabolic surgery (high blood pressure, diabetes, high cholesterol). The ideal procedure for a particular individual depends on a variety of factors such as Body Mass Index (BMI) and presence of other health issues.

Bariatric surgery is also now recognized as a valuable adjunct for sustained weight loss in individuals who were previously obese. This is especially true for those who have tried multiple times to lose weight, but always find their weight rebounding after losing a few kilograms.

The following procedures are performed at our centre:

1. Endoscopic Intra-gastric balloon
2. Laparoscopic Sleeve Gastrectomy
3. Laparoscopic Mini Gastric Bypass
4. Laparoscopic Roux-en-y Gastric Bypass

Nutritional Support Team

Besides diseases of the oesophagus and stomach, the UGI unit also manages the Nutritional Support Team (NST). The NST is a multi-disciplinary team, consisting of surgeons, dietitians, pharmacists, and nurses. It provides advice and intervention to optimize a patient’s nutritional status, as optimum nutrition leads to enhanced recovery and reduced complications during a patient’s stay in hospital, thus achieving the best possible outcome for a patient.

Vision

To be a world-class centre for treatment of malignant UGI diseases, and bariatric and metabolic surgery.

Mission

To deliver high-quality, comprehensive, up-to-date treatment for benign and malignant UGI diseases, and to deliver holistic, long-term support for patients undergoing bariatric and metabolic procedures.

1. Endoscopy (Diagnostic and Therapeutic)

• every Monday and Tuesday
• ranges from simple diagnostic procedures (E.G. Oesophago-gastroduodenoscopy [OGDS] and colonoscopy), to complex endoscopic interventions (E.G. Oesophageal stenting, Per-Oral Endoscopic Myotomy (POEM), Oesophageal manometry, Intra-gastric Balloons)
  

2. Day Care Surgery

• where patients come to hospital, have surgery done, and go home on the same day
• limited to low risk, straightforward procedures such as laparoscopic inguinal hernia repair and fundoplications
• requires patients to stay within 60 minutes of the hospital, and have a care giver that can help transport them to and from hospital on the day of surgery

3. Out-patient consultations

• every Thursday morning, 8am – 1pm
• consultations with specialists regarding the full breadth of UGI diseases
• multi-disciplinary consultations with dietitians for bariatric and metabolic procedures

4. In-patient surgery

• reserved for high risk, complex procedures, such as oesophagectomies and gastric bypass surgery

The UGI unit is strongly affiliated with the Malaysian Upper Gastro-Intestinal Society (MUGIS) and the Society of Endoscopic-Laparoscopic Surgeons of Malaysia (SELSMA). Together, educational workshops for surgical trainees and surgeons are organized on a regular basis.

The unit also has ties with Ng Teng Fong Hospital (NTFH) in Singapore, which allows for a free exchange of ideas and experience between the centres. Fortnightly video conferencing meetings are held between the two centres, where complicated cases are discussed. Together, this shared experience helps surgeons at both centres make decisions for complex cases to achieve the best outcome possible.

We work hard to produce high-quality research articles, which add to ever-growing pool of knowledge in the area of UGI diseases. We collaborate with international working groups, as well as other departments within UMMC’s Faculty of Medicine, primarily oncology and gastro-enterology.

International collaborations:

• Oesophago-Gastric Anastomosis working group
• COVIDsurg Collaborative
• GENEVA Study