Peptic ulcer surgery
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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
Perforated peptic ulcer is a surgical emergency and requires surgical repair of the perforation. Most bleeding ulcers require endoscopy urgently to stop bleeding with cauterizations or injection.
Surgery
Indications for surgical treatment of peptic ulcer:
- Bleeding peptic ulcer
- Perforated peptic ulcer
| Surgical options for peptic ulcer disease |
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| Oversew |
| 3-point ligation of gastroduodenal artery |
| Vagotomy and pyloroplasty |
| Vagotomy and antrectomy |
| Highly selective vagotomy |
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.
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 is to perform an anterior longitudinal duodenotomy Classically a truncal vagotomy is then performed to reduce the risk of recurrent ulceration.
- ↑ 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.