Surgical treatment of Zollinger–Ellison syndrome in Hospital Cologne-Merheim

About the department

The Department of General and Abdominal Surgery, Colorectal Surgery, Hepatopancreatobiliary Surgery, Hernia Surgery, Endocrine Surgery, Vascular Surgery and Bariatric Surgery at the Hospital Cologne-Merheim offers surgical treatment for a wide range of diseases. The department performs operations for pathologies of the gastrointestinal tract, liver, pancreas, gallbladder, bile ducts, rectum, bowel, anus, thyroid gland, parathyroid glands, and adrenal glands. Particular competence is in the surgical treatment of stomach cancer, esophageal cancer, colon cancer, liver cancer, pancreatic cancer, gastrointestinal neuroendocrine tumors, gastrointestinal stromal tumors, and peritoneal carcinomatosis. Surgeons also specialize in the treatment of hernias, including inguinal hernias, umbilical hernias, and anterior abdominal wall hernias. The department admits patients with diseases of the vascular system, including occlusive peripheral arterial disease, carotid artery stenosis, and abdominal and thoracic aortic aneurysms. Another important focus in the department's clinical activity is bariatric surgery on patients with morbid obesity. The specialists excellently perform gastric banding, gastric bypass, sleeve gastroplasty, intragastric balloon placement, and biliopancreatic diversion with duodenal switch. The department regularly performs minimally invasive surgical techniques, promoting rapid postoperative recovery, minimizing pain, and practically eliminating health risks for the patient. The department's operating rooms have state-of-the-art equipment that allows for the most sparing and safe surgical treatment. The Head Physician of the department is Prof. Dr. med. Claus Eisenberger.

The department's team of abdominal surgeons operates on patients with benign and malignant abdominal diseases. The doctors have vast experience in the treatment of gastroesophageal reflux disease, achalasia cardia, Zenker's diverticulum, gastritis, stomach ulcers, benign neoplasms, and other pathologies. As a rule, patients with such pathologies are treated in close cooperation with gastroenterologists because many cases can be managed with drug therapy and/or endoscopic procedures. Complex cases, however, often require surgery. The patient's clinical case is therefore cooperatively considered by gastroenterologists and surgeons, after which they elaborate the optimal treatment regimen adapted to the needs of a specific patient.

The primary focus of the department's abdominal surgeons is to provide medical care to patients with gastrointestinal cancers, such as colon cancer, stomach cancer, pancreatic cancer, and esophageal cancer. The cornerstone of cancer treatment is the resection of a malignant tumor. The operation is complemented with chemotherapy, radiation therapy, targeted therapy, immunotherapy, and other conservative treatments. In advanced stages, malignancies of the digestive system often spread beyond the organ, affecting the peritoneum and lymph nodes. In such cases, a complete cytoreduction followed by hyperthermic intraperitoneal chemotherapy (HIPEC) is performed during surgery. During the procedure, a perfusion apparatus is used to deliver heated chemotherapy agents (40°C or higher) to the abdominal cavity after tumor removal. An important advantage of the HIPEC procedure is the local effect on the tumor, thanks to which the dose of chemotherapy drugs can be significantly increased without fear of severe side effects. An additional therapeutic effect is provided by heating chemotherapy agents, which increases their ability to penetrate into deep structures.

In the field of colorectal surgery, the department's specialists help patients with rectal, bowel, and anal diseases. The specialists most often treat anal cancer, hemorrhoids, anal eczema, anal fissures, sphincter dysfunction, rectal prolapse, anal prolapse, rectocele, anal abscesses, and other pathologies. The most demanded operations in this area include the Longo procedure, the STARR procedure, sphincter reconstruction, rectopexy, sacral neuromodulation, pilonidal cyst excision, and the Karydakis flap procedure.

The department's team of endocrine surgeons specializes in the treatment of thyroid diseases. Of particular interest is the treatment of thyroid cancer: papillary, follicular, medullary, and anaplastic. Diagnosis involves ultrasound scans, laboratory tests, biopsy, and scintigraphy. The main treatment method is tumor resection or total thyroid removal surgery, such as hemithyroidectomy or total thyroidectomy. Surgical procedures are performed using minimally invasive techniques using modern neuromonitoring systems to prevent damage to the recurrent laryngeal nerve. Radioiodine therapy and hormone therapy are used as complementary treatments to surgery.

The department has also gained successful experience in the surgical treatment of morbid obesity. It is important to realize that surgery is the last-line treatment after unsuccessful attempts to get rid of excess weight through diet and physical exercise. The department's surgeons perform all bariatric surgical procedures available in modern medicine, including gastric banding, gastric bypass, sleeve gastrectomy, intragastric balloon placement, and biliopancreatic diversion with duodenal switch. These interventions are performed using minimally invasive techniques and have high success rates.

It is worth noting that the department has been recognized as a Competence Center for Minimally Invasive Surgery certified by the German Society for General and Abdominal Surgery (DGAV) since February 2013. Surgeons work in state-of-the-art operating rooms using state-of-the-art equipment for minimally invasive interventions. Such surgical procedures have a number of advantages, including better aesthetic results, minimal pain, faster patient recovery after surgery, and a shorter hospital stay. It is noteworthy that this minimally invasive approach is as effective as conventional open surgery.

The department also successfully practices natural orifice transluminal endoscopic surgery (NOTES). Operations on abdominal organs are performed through the oral cavity or rectum, avoiding the formation of scars. Currently, this technique is also used for gallbladder removal in women through the vagina.

The department's surgical options include:

• Surgery for gastrointestinal and peritoneal diseases
  • Surgery for malignant diseases
    • Surgery for stomach cancer
    • Surgery for colon cancer
    • Surgery for esophageal cancer
    • Surgery for pancreatic cancer
    • Surgery for retroperitoneal cancer: peritoneal mesothelioma, peritoneal carcinomatosis, and appendiceal cancer spread to peritoneum
  • Surgery for benign diseases
    • Surgery for benign neoplasms
    • Surgery for gastroesophageal reflux disease
    • Surgery for achalasia cardia
    • Surgery for gastritis
    • Surgery for peptic ulcer disease
    • Surgery for inflammatory bowel disease: Crohn's disease and ulcerative colitis
• Surgery for rectal, colon, and anal diseases
  • Milligan-Morgan hemorrhoidectomy and Longo procedure for hemorrhoids
  • Resection rectopexy for rectal prolapse
  • Fissurotomy and flap anorectoplasty for anal fissures
  • Surgery for malignant anal and rectal tumor resection
  • Sacral neuromodulation and sphincter reconstruction for fecal incontinence
• Surgery for liver, gallbladder, and bile duct diseases
  • Surgery for malignant diseases
    • Surgery for liver cancer and liver metastases
    • Surgery for gallbladder cancer
  • Surgery for benign diseases
    • Surgery for gallstone disease
    • Surgery for acute and chronic cholecystitis
    • Surgery for benign liver and gallbladder tumors
• Hernia repair surgery
  • Shouldice repair
  • Transabdominal preperitoneal (TAPP) hernia repair
  • Intraperitoneal onlay mesh (IPOM) technique for hernia repair
• Surgery for thyroid, parathyroid, and adrenal diseases
  • Hemithyroidectomy and thyroidectomy for thyroid cancer
  • Parathyroidectomy for  parathyroid diseases
  • Adrenalectomy for adrenal diseases
• Surgery for diseases of the vascular system
  • Surgery for occlusive peripheral arterial disease
  • Surgery for carotid artery stenosis
  • Surgery for diabetic foot syndrome
  • Surgery for abdominal and thoracic aortic aneurysms
  • Surgery for varicose veins
  • Surgery for deep vein thrombosis
  • Surgery for traumatic vascular injuries
• Surgery for morbid obesity
  • Intragastric balloon placement
  • Gastric banding
  • Gastric bypass surgery
  • Sleeve gastrectomy
  • Biliopancreatic diversion with duodenal switch
• Other medical services