Peptic ulcer surgery: Difference between revisions
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==Surgery== | ==Surgery== | ||
===Indications=== | ===Indications=== | ||
Indications for surgical treatment of peptic ulcer: | *Indications for surgical treatment of peptic ulcer: | ||
*Bleeding peptic ulcer | :*Bleeding peptic ulcer | ||
*Perforated peptic ulcer | :*Perforated peptic ulcer | ||
===Surgical Options=== | |||
==Bleeding peptic ulcer== | ==='''Bleeding peptic ulcer'''=== | ||
The primary goal of a bleeding peptic ulcer is hemorrhage control.The preferred operative approach to a peptic ulcer depends on the location of the ulcer, and for this, it is important for the surgeon to be present during upper GI endoscopy to have precise information on the location of the ulcer.It is discussed under two subtypes: Bleeding gastric ulcer and duodenal ulcer. | The primary goal of a bleeding peptic ulcer is hemorrhage control.The preferred operative approach to a peptic ulcer depends on the location of the ulcer, and for this, it is important for the surgeon to be present during upper GI endoscopy to have precise information on the location of the ulcer.It is discussed under two subtypes: Bleeding gastric ulcer and duodenal ulcer. | ||
Different surgical treatment options for refractory or complicated peptic ulcer disease are: | Different surgical treatment options for refractory or complicated peptic ulcer disease are: | ||
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*Gastrojejunal reconstruction (Billroth II) | *Gastrojejunal reconstruction (Billroth II) | ||
*Highly selective vagotomy | *Highly selective vagotomy | ||
====Bleeding gastric ulcers==== | |||
==Bleeding gastric ulcers== | |||
Bleeding gastric ulcers are treated according to the location of ulcers.They are generally best treated by excision of the ulcer and repair of the resulting gastric defect. Excision or biopsy of the ulcer is important, as 4–5% of benign-appearing ulcers are actually malignant ulcers.<ref name="pmid4014553">{{cite journal |vauthors=Csendes A, Braghetto I, Calvo F, De la Cuadra R, Velasco N, Schutte H, Sepulveda A, Lazo M |title=Surgical treatment of high gastric ulcer |journal=Am. J. Surg. |volume=149 |issue=6 |pages=765–70 |year=1985 |pmid=4014553 |doi= |url=}}</ref> | Bleeding gastric ulcers are treated according to the location of ulcers.They are generally best treated by excision of the ulcer and repair of the resulting gastric defect. Excision or biopsy of the ulcer is important, as 4–5% of benign-appearing ulcers are actually malignant ulcers.<ref name="pmid4014553">{{cite journal |vauthors=Csendes A, Braghetto I, Calvo F, De la Cuadra R, Velasco N, Schutte H, Sepulveda A, Lazo M |title=Surgical treatment of high gastric ulcer |journal=Am. J. Surg. |volume=149 |issue=6 |pages=765–70 |year=1985 |pmid=4014553 |doi= |url=}}</ref> | ||
*Ulcers along the greater curvature of the stomach, antrum or body of the stomach wedge excision of the ulcer and closure of the resulting defect can easily be achieved in most cases without causing significant deformation of the stomach. | *Ulcers along the greater curvature of the stomach, antrum or body of the stomach wedge excision of the ulcer and closure of the resulting defect can easily be achieved in most cases without causing significant deformation of the stomach. | ||
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* Distal gastric ulcers along the lesser curvature in the area of the incisura angularis, a distal gastrectomy with either a Billroth I or Billroth II reconstruction is the common method of excising the ulcer and restoring GI continuity. | * Distal gastric ulcers along the lesser curvature in the area of the incisura angularis, a distal gastrectomy with either a Billroth I or Billroth II reconstruction is the common method of excising the ulcer and restoring GI continuity. | ||
*Proximal gastric ulcer near the gastroesophageal (GE) junction. Csendes procedure, a distal gastrectomy with the tongue-shaped extension of the lesser curve resection margin to include the ulcer and subsequent Roux-Y esophagogastrojenjunostomy is an excellent option<ref name="pmid40145532">{{cite journal |vauthors=Csendes A, Braghetto I, Calvo F, De la Cuadra R, Velasco N, Schutte H, Sepulveda A, Lazo M |title=Surgical treatment of high gastric ulcer |journal=Am. J. Surg. |volume=149 |issue=6 |pages=765–70 |year=1985 |pmid=4014553 |doi= |url=}}</ref> | *Proximal gastric ulcer near the gastroesophageal (GE) junction. Csendes procedure, a distal gastrectomy with the tongue-shaped extension of the lesser curve resection margin to include the ulcer and subsequent Roux-Y esophagogastrojenjunostomy is an excellent option<ref name="pmid40145532">{{cite journal |vauthors=Csendes A, Braghetto I, Calvo F, De la Cuadra R, Velasco N, Schutte H, Sepulveda A, Lazo M |title=Surgical treatment of high gastric ulcer |journal=Am. J. Surg. |volume=149 |issue=6 |pages=765–70 |year=1985 |pmid=4014553 |doi= |url=}}</ref> | ||
=Bleeding duodenal ulcers= | ====Bleeding duodenal ulcers==== | ||
The standard approach to a bleeding duodenal ulcer | The standard approach to a bleeding duodenal ulcer | ||
* Perform an anterior longitudinal duodenotomy | * Perform an anterior longitudinal duodenotomy | ||
*Classically a truncal vagotomy is performed to reduce the risk of recurrent ulceration | *Classically a truncal vagotomy is performed to reduce the risk of recurrent ulceration | ||
*TAE should be the first line therapy for recurrent bleeding after duodenotomy and ulcer oversewing.<ref name="pmid28058023">{{cite journal |vauthors=Ichikawa D, Komatsu S, Dohi O, Naito Y, Kosuga T, Kamada K, Okamoto K, Itoh Y, Otsuji E |title=Laparoscopic and endoscopic co-operative surgery for non-ampullary duodenal tumors |journal=World J. Gastroenterol. |volume=22 |issue=47 |pages=10424–10431 |year=2016 |pmid=28058023 |pmc=5175255 |doi=10.3748/wjg.v22.i47.10424 |url=}}</ref><ref name="pmid27097695">{{cite journal |vauthors=Zhuang ZH, Lin AF, Tang DP, Wei JJ, Liu ZJ, Xin XM, Pan YF |title=Association of Endoscopic Esophageal Variceal Ligation with Duodenal Ulcer |journal=J Coll Physicians Surg Pak |volume=26 |issue=4 |pages=267–71 |year=2016 |pmid=27097695 |doi=2289 |url=}}</ref><ref name="pmid10674604">{{cite journal |vauthors=Ng EK, Lam YH, Sung JJ, Yung MY, To KF, Chan AC, Lee DW, Law BK, Lau JY, Ling TK, Lau WY, Chung SC |title=Eradication of Helicobacter pylori prevents recurrence of ulcer after simple closure of duodenal ulcer perforation: randomized controlled trial |journal=Ann. Surg. |volume=231 |issue=2 |pages=153–8 |year=2000 |pmid=10674604 |pmc=1420980 |doi= |url=}}</ref><ref name="pmid12520581">{{cite journal |vauthors=Gilliam AD, Speake WJ, Lobo DN, Beckingham IJ |title=Current practice of emergency vagotomy and Helicobacter pylori eradication for complicated peptic ulcer in the United Kingdom |journal=Br J Surg |volume=90 |issue=1 |pages=88–90 |year=2003 |pmid=12520581 |doi=10.1002/bjs.4003 |url=}}</ref><ref name="pmid8273376">{{cite journal |vauthors=Millat B, Hay JM, Valleur P, Fingerhut A, Fagniez PL |title=Emergency surgical treatment for bleeding duodenal ulcer: oversewing plus vagotomy versus gastric resection, a controlled randomized trial. French Associations for Surgical Research |journal=World J Surg |volume=17 |issue=5 |pages=568–73; discussion 574 |year=1993 |pmid=8273376 |doi= |url=}}</ref><ref name="pmid1760699">{{cite journal |vauthors=Poxon VA, Keighley MR, Dykes PW, Heppinstall K, Jaderberg M |title=Comparison of minimal and conventional surgery in patients with bleeding peptic ulcer: a multicentre trial |journal=Br J Surg |volume=78 |issue=11 |pages=1344–5 |year=1991 |pmid=1760699 |doi= |url=}}</ref><ref name="pmid18755604">{{cite journal |vauthors=Eriksson LG, Ljungdahl M, Sundbom M, Nyman R |title=Transcatheter arterial embolization versus surgery in the treatment of upper gastrointestinal bleeding after therapeutic endoscopy failure |journal=J Vasc Interv Radiol |volume=19 |issue=10 |pages=1413–8 |year=2008 |pmid=18755604 |doi=10.1016/j.jvir.2008.06.019 |url=}}</ref><ref name="pmid16613304">{{cite journal |vauthors=Holme JB, Nielsen DT, Funch-Jensen P, Mortensen FV |title=Transcatheter arterial embolization in patients with bleeding duodenal ulcer: an alternative to surgery |journal=Acta Radiol |volume=47 |issue=3 |pages=244–7 |year=2006 |pmid=16613304 |doi= |url=}}</ref> | *TAE should be the first line therapy for recurrent bleeding after duodenotomy and ulcer oversewing.<ref name="pmid28058023">{{cite journal |vauthors=Ichikawa D, Komatsu S, Dohi O, Naito Y, Kosuga T, Kamada K, Okamoto K, Itoh Y, Otsuji E |title=Laparoscopic and endoscopic co-operative surgery for non-ampullary duodenal tumors |journal=World J. Gastroenterol. |volume=22 |issue=47 |pages=10424–10431 |year=2016 |pmid=28058023 |pmc=5175255 |doi=10.3748/wjg.v22.i47.10424 |url=}}</ref><ref name="pmid27097695">{{cite journal |vauthors=Zhuang ZH, Lin AF, Tang DP, Wei JJ, Liu ZJ, Xin XM, Pan YF |title=Association of Endoscopic Esophageal Variceal Ligation with Duodenal Ulcer |journal=J Coll Physicians Surg Pak |volume=26 |issue=4 |pages=267–71 |year=2016 |pmid=27097695 |doi=2289 |url=}}</ref><ref name="pmid10674604">{{cite journal |vauthors=Ng EK, Lam YH, Sung JJ, Yung MY, To KF, Chan AC, Lee DW, Law BK, Lau JY, Ling TK, Lau WY, Chung SC |title=Eradication of Helicobacter pylori prevents recurrence of ulcer after simple closure of duodenal ulcer perforation: randomized controlled trial |journal=Ann. Surg. |volume=231 |issue=2 |pages=153–8 |year=2000 |pmid=10674604 |pmc=1420980 |doi= |url=}}</ref><ref name="pmid12520581">{{cite journal |vauthors=Gilliam AD, Speake WJ, Lobo DN, Beckingham IJ |title=Current practice of emergency vagotomy and Helicobacter pylori eradication for complicated peptic ulcer in the United Kingdom |journal=Br J Surg |volume=90 |issue=1 |pages=88–90 |year=2003 |pmid=12520581 |doi=10.1002/bjs.4003 |url=}}</ref><ref name="pmid8273376">{{cite journal |vauthors=Millat B, Hay JM, Valleur P, Fingerhut A, Fagniez PL |title=Emergency surgical treatment for bleeding duodenal ulcer: oversewing plus vagotomy versus gastric resection, a controlled randomized trial. French Associations for Surgical Research |journal=World J Surg |volume=17 |issue=5 |pages=568–73; discussion 574 |year=1993 |pmid=8273376 |doi= |url=}}</ref><ref name="pmid1760699">{{cite journal |vauthors=Poxon VA, Keighley MR, Dykes PW, Heppinstall K, Jaderberg M |title=Comparison of minimal and conventional surgery in patients with bleeding peptic ulcer: a multicentre trial |journal=Br J Surg |volume=78 |issue=11 |pages=1344–5 |year=1991 |pmid=1760699 |doi= |url=}}</ref><ref name="pmid18755604">{{cite journal |vauthors=Eriksson LG, Ljungdahl M, Sundbom M, Nyman R |title=Transcatheter arterial embolization versus surgery in the treatment of upper gastrointestinal bleeding after therapeutic endoscopy failure |journal=J Vasc Interv Radiol |volume=19 |issue=10 |pages=1413–8 |year=2008 |pmid=18755604 |doi=10.1016/j.jvir.2008.06.019 |url=}}</ref><ref name="pmid16613304">{{cite journal |vauthors=Holme JB, Nielsen DT, Funch-Jensen P, Mortensen FV |title=Transcatheter arterial embolization in patients with bleeding duodenal ulcer: an alternative to surgery |journal=Acta Radiol |volume=47 |issue=3 |pages=244–7 |year=2006 |pmid=16613304 |doi= |url=}}</ref> | ||
==Perforated peptic ulcer== | ====Perforated peptic ulcer==== | ||
*Laparoscopic closure of perforated peptic ulcer is the treatment of choice.<ref name="pmid20033725">{{cite journal |vauthors=Bertleff MJ, Lange JF |title=Laparoscopic correction of perforated peptic ulcer: first choice? A review of literature |journal=Surg Endosc |volume=24 |issue=6 |pages=1231–9 |year=2010 |pmid=20033725 |pmc=2869436 |doi=10.1007/s00464-009-0765-z |url=}}</ref> | *Laparoscopic closure of perforated peptic ulcer is the treatment of choice.<ref name="pmid20033725">{{cite journal |vauthors=Bertleff MJ, Lange JF |title=Laparoscopic correction of perforated peptic ulcer: first choice? A review of literature |journal=Surg Endosc |volume=24 |issue=6 |pages=1231–9 |year=2010 |pmid=20033725 |pmc=2869436 |doi=10.1007/s00464-009-0765-z |url=}}</ref> | ||
Revision as of 23:25, 20 November 2017
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Peptic ulcer Microchapters |
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Diagnosis |
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Treatment |
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Surgery |
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Case Studies |
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2017 ACG Guidelines for Peptic Ulcer Disease |
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Guidelines for the Indications to Test for, and to Treat, H. pylori Infection |
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Guidlines for factors that predict the successful eradication when treating H. pylori infection |
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Guidelines to document H. pylori antimicrobial resistance in the North America |
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Guidelines for evaluation and testing of H. pylori antibiotic resistance |
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Guidelines for when to test for treatment success after H. pylori eradication therapy |
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Guidelines for penicillin allergy in patients with H. pylori infection |
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Peptic ulcer surgery On the Web |
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American Roentgen Ray Society Images of Peptic ulcer surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ;Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]
Overview
Surgery
Indications
- Indications for surgical treatment of peptic ulcer:
- Bleeding peptic ulcer
- Perforated peptic ulcer
Surgical Options
Bleeding peptic ulcer
The primary goal of a bleeding peptic ulcer is hemorrhage control.The preferred operative approach to a peptic ulcer depends on the location of the ulcer, and for this, it is important for the surgeon to be present during upper GI endoscopy to have precise information on the location of the ulcer.It is discussed under two subtypes: Bleeding gastric ulcer and duodenal ulcer. Different surgical treatment options for refractory or complicated peptic ulcer disease are:
- Vagotomy and pyloroplasty
- Vagotomy and antrectomy with gastroduodenal reconstruction (Billroth I)
- Gastrojejunal reconstruction (Billroth II)
- Highly selective vagotomy
Bleeding gastric ulcers
Bleeding gastric ulcers are treated according to the location of ulcers.They are generally best treated by excision of the ulcer and repair of the resulting gastric defect. Excision or biopsy of the ulcer is important, as 4–5% of benign-appearing ulcers are actually malignant ulcers.[1]
- Ulcers along the greater curvature of the stomach, antrum or body of the stomach wedge excision of the ulcer and closure of the resulting defect can easily be achieved in most cases without causing significant deformation of the stomach.
- Gastric ulcers along the lesser curvature of the stomach are more difficult because of the rich arcade of vessels from the left gastric artery, wedge excision of these ulcers is more difficult and the subsequent closure of the gastric defect result in deformation of the stomach and either luminal obstruction or gastric volvulus of the resulting J-shaped stomach
- Distal gastric ulcers along the lesser curvature in the area of the incisura angularis, a distal gastrectomy with either a Billroth I or Billroth II reconstruction is the common method of excising the ulcer and restoring GI continuity.
- Proximal gastric ulcer near the gastroesophageal (GE) junction. Csendes procedure, a distal gastrectomy with the tongue-shaped extension of the lesser curve resection margin to include the ulcer and subsequent Roux-Y esophagogastrojenjunostomy is an excellent option[2]
Bleeding duodenal ulcers
The standard approach to a bleeding duodenal ulcer
- Perform an anterior longitudinal duodenotomy
- Classically a truncal vagotomy is performed to reduce the risk of recurrent ulceration
- TAE should be the first line therapy for recurrent bleeding after duodenotomy and ulcer oversewing.[3][4][5][6][7][8][9][10]
Perforated peptic ulcer
- Laparoscopic closure of perforated peptic ulcer is the treatment of choice.[11]
References
- ↑ Csendes A, Braghetto I, Calvo F, De la Cuadra R, Velasco N, Schutte H, Sepulveda A, Lazo M (1985). "Surgical treatment of high gastric ulcer". Am. J. Surg. 149 (6): 765–70. PMID 4014553.
- ↑ Csendes A, Braghetto I, Calvo F, De la Cuadra R, Velasco N, Schutte H, Sepulveda A, Lazo M (1985). "Surgical treatment of high gastric ulcer". Am. J. Surg. 149 (6): 765–70. PMID 4014553.
- ↑ Ichikawa D, Komatsu S, Dohi O, Naito Y, Kosuga T, Kamada K, Okamoto K, Itoh Y, Otsuji E (2016). "Laparoscopic and endoscopic co-operative surgery for non-ampullary duodenal tumors". World J. Gastroenterol. 22 (47): 10424–10431. doi:10.3748/wjg.v22.i47.10424. PMC 5175255. PMID 28058023.
- ↑ Zhuang ZH, Lin AF, Tang DP, Wei JJ, Liu ZJ, Xin XM, Pan YF (2016). "Association of Endoscopic Esophageal Variceal Ligation with Duodenal Ulcer". J Coll Physicians Surg Pak. 26 (4): 267–71. doi:2289 Check
|doi=value (help). PMID 27097695. - ↑ Ng EK, Lam YH, Sung JJ, Yung MY, To KF, Chan AC, Lee DW, Law BK, Lau JY, Ling TK, Lau WY, Chung SC (2000). "Eradication of Helicobacter pylori prevents recurrence of ulcer after simple closure of duodenal ulcer perforation: randomized controlled trial". Ann. Surg. 231 (2): 153–8. PMC 1420980. PMID 10674604.
- ↑ Gilliam AD, Speake WJ, Lobo DN, Beckingham IJ (2003). "Current practice of emergency vagotomy and Helicobacter pylori eradication for complicated peptic ulcer in the United Kingdom". Br J Surg. 90 (1): 88–90. doi:10.1002/bjs.4003. PMID 12520581.
- ↑ Millat B, Hay JM, Valleur P, Fingerhut A, Fagniez PL (1993). "Emergency surgical treatment for bleeding duodenal ulcer: oversewing plus vagotomy versus gastric resection, a controlled randomized trial. French Associations for Surgical Research". World J Surg. 17 (5): 568–73, discussion 574. PMID 8273376.
- ↑ Poxon VA, Keighley MR, Dykes PW, Heppinstall K, Jaderberg M (1991). "Comparison of minimal and conventional surgery in patients with bleeding peptic ulcer: a multicentre trial". Br J Surg. 78 (11): 1344–5. PMID 1760699.
- ↑ Eriksson LG, Ljungdahl M, Sundbom M, Nyman R (2008). "Transcatheter arterial embolization versus surgery in the treatment of upper gastrointestinal bleeding after therapeutic endoscopy failure". J Vasc Interv Radiol. 19 (10): 1413–8. doi:10.1016/j.jvir.2008.06.019. PMID 18755604.
- ↑ Holme JB, Nielsen DT, Funch-Jensen P, Mortensen FV (2006). "Transcatheter arterial embolization in patients with bleeding duodenal ulcer: an alternative to surgery". Acta Radiol. 47 (3): 244–7. PMID 16613304.
- ↑ Bertleff MJ, Lange JF (2010). "Laparoscopic correction of perforated peptic ulcer: first choice? A review of literature". Surg Endosc. 24 (6): 1231–9. doi:10.1007/s00464-009-0765-z. PMC 2869436. PMID 20033725.