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
Surgery for peptic ulcer is indicated for bleeding and perforated peptic ulcer. Bleeding ulcers are usually treated first with endoscopic therapy but if they bleed after endoscopic therapy, surgery is done to control bleeding. Perforated peptic ulcer is an emergency, immediate laparoscopic closure of ulcer is required.
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
- duodenal ulcer
Different surgical treatment options for refractory or complicated bleeding 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][2]
- Ulcers along the greater curvature and lesser curvature of the stomach, antrum or body of the stomach are treated by:
- Wedge excision of the ulcer and closure of the defect
- Distal gastric ulcers along the lesser curvature in the area of the incisura angularis are treated by:
- A distal gastrectomy with either a Billroth I or Billroth II reconstruction
- Proximal gastric ulcer near the gastroesophageal (GE) junction are treated by:
- Csendes procedure, a distal gastrectomy with the tongue-shaped extension of the lesser curve resection margin to include the ulcer
- Further Roux-en-Y esophagogastrojenjunostomy is done to prevent defects of stomach
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
- Transcatheter arterial embolization(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
- Perforated peptic ulcer is an surgical emergency
- Immediate 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.