PEPTIC-ULCER SURGERY

General Information

DEFINITION--Surgery to treat the complications of peptic ulcer disease, especially destruction of the protective lining of the gastrointestinal tract that leads to ulcer craters.

BODY PARTS INVOLVED--Esophagus; stomach; duodenum; jejunum.

REASONS FOR SURGERY--

Treatment of complications of peptic ulcers:

• Bleeding. > Intolerable pain. > Blockage of stomach contents from emptying. > Perforation. If an ulcer perforates, the contents of the gastrointestinal tract are dumped into the abdominal cavity, causing peritonitis. This is a medical emergency requiring immediate surgery.

SURGICAL RISK INCREASES WITH

• Adults over 60.
• Stress.
• Alcoholism.
• Chronic illness.
• Poor nutrition, especially vitamin and mineral deficiencies.
• Use of any drugs that irritate the stomach.
• Pancreatitis; hepatitis; diabetes mellitus; brain tumor; or extensive burns.

What To Expect

WHO OPERATES--General surgeon.

WHERE PERFORMED--Hospital.

DIAGNOSTIC TESTS

• Before surgery: Blood and urine studies; x-rays of abdomen; endoscopy (See Glossary).
• After surgery:Blood and urine studies; x-rays of abdomen.

ANESTHESIA--General anesthesia by injection and inhalation with an airway tube placed in the windpipe.

DESCRIPTION OF OPERATION--

Any of the following procedures is used to perform this surgery:

• Vagotomy and pyloroplasty: The nerves that stimulate stomach-acid production are severed, and the outlet of the stomach that leads to the duodenum is enlarged. > Gastric resection: The lower part of the stomach that produces acid is removed, and the remaining stomach is attached with sutures to the duodenum or the jejunum. > Closure of perforated ulcer: The perforated ulcer is closed by various methods. Incisions that are made are closed with sutures or clips, which usually can be removed about 1 week after surgery.

POSSIBLE COMPLICATIONS

• Excessive bleeding.
• Surgical-wound infection.
• Incisional hernia.
• Recurrence of peptic ulcer.
• Chronic diarrhea.
• Dumping syndrome.
• Malnutrition.

AVERAGE HOSPITAL STAY--6 to 8 days.

PROBABLE OUTCOME--Expect complete healing without complications. Allow about 4 to 6 weeks for recovery from surgery.

Postoperative Care

GENERAL MEASURES

• Don't smoke.
• A hard ridge should form along the incision. As it heals, the ridge will recede gradually.
• Bathe and shower as usual. You may wash the incision gently with mild unscented soap.
• Use an electric heating pad, a heat lamp or a warm compress to relieve incisional pain.

MEDICATION---Your doctor may prescribe pain relievers. Don't take prescription pain medication longer than 4 to 7 days. Use only as much as you need. Don't take aspirin.

† To help recovery and aid your well--

being, resume daily activities, including work, as soon as you are able.

• Resume driving about 2 weeks after returning home.

DIET--Clear liquid diet until the gastrointestinal tract functions again. Then eat a well--balanced diet to promote healing. Avoid coffee, tea, cocoa, cola drinks, alcoholic beverages and any food or spice that aggravates symptoms.

Call Your Doctor If

Any of the following occurs:

• Increased pain, swelling, redness, drainage or bleeding in the surgical area.
• Headache, muscle aches, dizziness or a general ill feeling and fever.
• Increasing abdominal pain or swelling; constipation; nausea; vomiting; bleeding from the rectum or black, tarry stools.
• New, unexplained symptoms develop. Drugs used in treatment may produce side effects.