What are the different types of abdominal surgery?

Types of Abdominal Surgery

Abdominal surgery encompasses numerous procedures targeting different organs and pathologies, broadly categorized by anatomic location, surgical approach, and clinical indication.

Major Categories of Abdominal Surgery

Emergency vs. Elective Procedures

Emergency abdominal surgery is performed for life-threatening conditions requiring immediate intervention, including peritonitis, perforation, bowel obstruction, bleeding, toxic megacolon, and vascular catastrophes. 1 Surgery must be performed within 12-24 hours of presentation to optimize outcomes and reduce mortality. 2

Elective procedures are scheduled in advance for conditions like cancer resection, hernia repair, or bariatric surgery. 1

By Surgical Approach

• Open surgery: Traditional approach using large incisions, preferred for hemodynamically unstable patients, free perforations, toxic megacolon, or when rapid source control is needed. 1, 3

• Laparoscopic surgery: Minimally invasive technique using small incisions and cameras, now the gold standard for appendectomy, cholecystectomy, bariatric procedures, and colorectal resections, with reduced perioperative morbidity and shorter hospital stays. 4, 5, 3 Multi-port laparoscopic approaches are recommended over single-port in emergency settings. 1

• Robotic surgery: Advanced minimally invasive approach providing three-dimensional visualization and enhanced precision, though data supporting its use in emergency settings remain limited. 1, 6

• Damage control surgery with open abdomen: Abbreviated surgical procedure with temporary abdominal closure for critically ill patients with severe peritonitis, septic shock, hemodynamic instability, extensive intestinal ischemia, or massive hemoperitoneum. 1 This staged approach includes initial source control, continued resuscitation, and delayed definitive treatment. 1, 7

By Anatomic Region and Organ System

Upper Gastrointestinal Surgery:

• Esophageal procedures: Esophagectomy with pyloroplasty when stomach is used as esophageal substitute. 8
• Gastric procedures: Gastrectomy (partial or total), gastric bypass (Roux-en-Y), gastroplasty, gastric banding, sleeve gastrectomy, Billroth I (gastroduodenal anastomosis), Billroth II procedures. 1, 9 Gastric per-oral endoscopic myotomy (G-POEM) for refractory gastroparesis. 8
• Duodenal procedures: Primary repair of perforated ulcers with omental patch, pancreas-sparing duodenectomy, pyloric exclusion. 1

Hepatobiliary and Pancreatic Surgery:

• Cholecystectomy (laparoscopic is gold standard). 5
• Liver resections (require experienced surgeon). 5
• Pancreatic resections (specialized procedures). 5
• Biliopancreatic diversion with or without duodenal switch. 1

Small Bowel Surgery:

• Bowel resection for obstruction, perforation, or ischemia. 1
• Strictureplasty for Crohn's disease (typically elective). 1
• Jejunostomy tube placement for nutritional support. 8
• Repair of jejuno-jejunal anastomotic complications. 1

Colorectal Surgery:

• Appendectomy (laparoscopic is routine). 4, 5
• Colonic resections (laparoscopic or open). 4, 5
• Subtotal colectomy for ulcerative colitis or Crohn's disease. 1
• Ileocecal resection. 1
• Stoma formation versus primary anastomosis decisions. 1

Vascular Surgery:

• Ruptured abdominal aortic aneurysm repair (open abdomen often required). 1
• Acute mesenteric ischemia management. 1

By Clinical Indication

Inflammatory Bowel Disease:

• Emergency surgery for medically resistant disease, bleeding, toxic megacolon, perforation in ulcerative colitis. 1
• Bowel obstruction, perforation, bleeding management in Crohn's disease. 1

Bariatric Surgery Complications:

• Management of marginal ulceration, gastro-gastric fistula, remnant stomach perforation, internal hernia, anastomotic leaks. 1

Peritonitis and Sepsis:

• Source control procedures including peritoneal lavage, bowel resection, abscess drainage. 1
• Re-laparotomy strategies: on-demand versus planned (every 36-48 hours). 1

Trauma:

• Damage control laparotomy for physiologic derangement (acidosis pH ≤7.2, hypothermia ≤34°C, coagulopathy, massive transfusion). 1

Critical Decision-Making Factors

Anastomosis versus stoma formation depends on: 1

• Patient hemodynamic stability
• Degree of peritoneal contamination
• Sepsis severity
• Tissue quality and perfusion
• Surgeon experience

Laparoscopic versus open approach depends on: 1, 3

• Hemodynamic stability (unstable patients require open)
• Surgeon expertise and availability
• Degree of bowel distension
• Presence of free perforation
• Need for rapid source control

Common pitfall: Delaying surgery when radiological findings are inconclusive but clinical signs (tachycardia ≥110 bpm, fever, hypotension, respiratory distress) suggest surgical emergency. 1, 2 The threshold to operate should be lower in these scenarios. 1