Resection for treatment of gastric and duodenal ulcers

This article is professionally consulted by resident Doctor Le Thanh Tuan - Department of General Surgery - Vinmec Nha Trang International Hospital. The doctor has extensive experience in examination, treatment and surgery of abdominal diseases.

Mechanism of gastritis - duodenal ulcer: The process of gastric secretion has a struggle between attacking factors (the secretion of hydrochloric acid and pepsin) capable of destroying the gastric mucosa and protective factors. mucus secretion) has the ability to protect the mucosa from destruction. When the protective factor is weakened and the offensive factor increases, peptic ulcer disease occurs.
The basis of surgical treatment based on the mechanism of gastric ulcer is to remove the cause of the ulcer, to reduce the gastric acidosis to the required level, not to remove the ulcer. Therefore, the gastroduodenal resection is the removal of the acid-secreting reflex area of ​​the stomach, the antrum, and the body by surgery to ensure two requirements:
Removal of the ulcer and removal of the pathogenic gastrectomy ulcer. Establish an oral gastrointestinal tract connecting the remaining gastric segment with the first loop of the jejunum. In addition, in some cases, due to a deep ulcer, 2/3 of the stomach can be cut, leaving an ulcer.

The doctor will appoint surgery in the case of peptic ulcer with serious complications such as:
In case of ulcer with complication of perforation, Uncontrollable gastrointestinal bleeding Complications of pyloric stenosis, cancer. Gastroduodenal ulcer that recurred with medical treatment did not help.

Gastroduodenal ulcer but not properly treated with internal therapy, no complications of stricture, gastrointestinal bleeding The patient is weak or has severe acute illness. Blood clotting disorder

The doctor will ask the patient to lie on his back, insert a nasogastric tube before surgery. The patient lies in a position with the head high, legs low at an angle of 30 degrees relative to the horizontal plane, legs at an angle of 90 degrees. The steps are as follows:
Laparotomy conduct exploration and assessment of lesions such as ulcer status, check other organs in the abdomen.
Conduct separation, release the large curvature of the stomach to resect and dissect the small curvature of the stomach, stopping bleeding. Dissection of the pyloric vascular bundle, paired with clips or ligation. Cut and close the duodenal apex. Ligation of the coronary artery by dissection, clip clip or ligation of the coronary artery. Gastrectomy with an endoscopic gastrectomy for about 2 rounds or with a knife Re-establish gastrointestinal circulation by mechanical finsterer gastrojejunostomy or manual suture laparoscopically. Examining, taking specimens for pathology Close the abdomen

The volume of the stomach that needs to be removed must be enough 2/3 to reduce the necessary gastric acidosis, no longer causing ulcers. At the same time, it is necessary to leave the remaining stomach part enough to ensure the necessary digestive function for the body.
Limit the cut on the stomach without dilatation, the small curvature is from 13-15cm in length and the large curvature is from 40-45cm. The small curvature must be resected at least 10cm and the large curvature at least 20cm. After partial gastrectomy, the remaining stomach is then connected to the duodenum or to the jejunum.

Injury to the common bile duct in the case of a deep ulcer, in the superior border, in the posterior surface of the duodenum and when the surgeon tries to remove the ulcer. Cut into the ampulla of Vater: This complication is very rare, the rate is about 1%, the prognosis is usually very severe. Injury to the pancreatic duct Splenic rupture: This rate is very low, the cause is often due to too strong movements while pulling the valve to open the incision, when pulling the stomach to release the great curvature and when wiping the abdomen. Occlusion of the anastomosis: This complication is uncommon and can be partially or completely blocked. Accordingly, the occlusion of the anastomosis is caused by bleeding of the anastomosis and fistula of the duodenal apex. Peptic ulcer disease is a dangerous disease that can leave many complications, so the treatment of peptic ulcer disease should be performed by qualified doctors as well as medical facilities. Modern medical supplies.
At Vinmec International General Hospital with a team of experienced doctors and a system of modern medical equipment, ensuring complete sterility to meet strict standards for internal surgery Gastroscopy in the treatment of diseases related to the stomach and duodenum.