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Laparoscopic Bypass and Laparoscopic Palliation for Cancer

The best treatment for cancer is surgery to remove this completely. Unfortunately, in some patients this may not be possible for a number of reasons. The cancer may already have spread to distant organs and curative surgery is no longer beneficial. The tumour itself may be large and invading into surrounding organs. Or the patient may be too old or too unfit for major surgery. In all these patients, we try to offer some other treatment to relieve any symptoms due to the cancer. Such treatment may include chemotherapy, radiotherapy or endoscopic treatment. In general, the less invasive the treatment the better. Nevertheless, we may sometimes still require some sort of surgery if palliation by non-surgical means is inadequate or not possible.

Previously, most of these operations were done by conventional open surgery. For example, in patients with digestive cancers such as gastric cancer and pancreatic cancer, a long abdominal incision is required. Most patients tend to take a long time to recover after surgery due to the large incisions used. Fortunately, we can now perform these procedures by a keyhole technique called Laparoscopic Palliation for Cancer. Depending on the procedure required, 3 to 5 small incisions (2 mm to 12 mm in size) are used to insert the telescope and operating instruments into the abdominal cavity. The entire operation is done without the need for a large incision. Examples of palliative procedures we can perform this include laparoscopic stoma formation (to relieve obstructed bowel from cancer), laparoscopic palliation of pain (by a nerve block or division of the nerves conducting the pain), and laparoscopic bypass.

Cancers in the abdominal cavity can cause bowel obstruction if they are large and block the alimentary tract. Intestinal obstruction leads to abdominal distension, vomiting and inability to eat or retain food. If obstruction occurs and the cancer cannot be removed, we can offer good symptomatic relief by bypassing the obstruction surgically. For example, in gastric cancers and pancreatic cancers, the outlet of the stomach can become completely blocked. A Laparoscopic Bypass can be done to connect the healthy part of the stomach to the small intestine using a stapling device.

Most patients recover more quickly after Laparoscopic Palliation compared to conventional open surgery. There is less wound pain and the bowels return to function rapidly. For example, patients can generally start to drink and eat three days after a Laparoscopic Gastric Bypass for an obstructed stomach.

A quick post-op recovery also means that we can initiate other treatment faster. We need not delay chemotherapy and radiotherapy as we do not have to worry about healing from a long incision from conventional open surgery.

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