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KMID : 0381219720040070420
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Journal of RIMSK
1972 Volume.4 No. 7 p.420 ~ p.423
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SURGICAL INDICATION OF PETTIC ULCER
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Abstract
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Peptic ulcers are characterized by local destruction of the mucous membrane of the upper gastrointestinal tract, mainly the stomach and duodenum. Occasionally the lower esophagus and upper jejunum are involved. It has become evident in recent years that there are fundamental differences between various types of mucosal lesions as well as their etiology. Various etiological factors, including hypersecretion of acid stimulated by the vagal phase of gastric secretion for duodenal ulcer and acid hypersecretion stimulated by gastrin are reviewed.
The choice of treatment for peptic ulcer is discussed with special emphasis on the use of surgical management in the treatment of gastric ulcers and medical management in the treatment of duodenal. ulcer.. Variations of surgical approaches for duodenal ulcers as well as their complications are described.
I. The three major types of surgical approaches today include subtotal gastrectomy, vagotomy alone? or combined with a procedure to facilitate gastric emptying and finally vagotomy coupled with partial gastric resection. The different procedures have certain merit and any surgeon should not only be familiar with the different techniques but also be willing to adapt the operation to the individual patient.
II. Surgical management of acute complications of a chronic duodenal ulcer requires aggressive diagnostic and therapeutic measures. After initial supportive therapy is given to alleviate symptoms and correct physiologic alterations produced by the acute problem accurate diagnosis should be sought. When surgical intervention is indicated, the choice of operation should be based on analysis of the many factors which influence operative risk, postoperative morbidity, and long-term results.
III. Surgical management of acute gastric and duodenal stress ulcer remains one of the challenging problems. Early surgical management including vagotomy with pyloroplasty or subtotal gastrectomy following conservative management for bleeding is to be emphasized.
IV. t.[n the surgical management of postoperative recurrent ulcers step’s should be taken to find its causative factors. In general if the ulceration has recurred after gastroenterostomy, or after pyloroplasty with, vagotomy, then gastric resection with vagotomy is indicated if not don during the first operation. If a vagotomy was done at the previous operation, most often gastric resection is the procedure of choice. The surgeon must also be certain that vagotomy is complete. When ulceration followings a gastric resection, then a vagotomy or resection may be used, or both. Lastly when endocrine abnormality is considered the basis for recurrent peptic ulceration, total gastrectomy most often is indicated,
as well as removal of the abnormal endocrine tissue if possible.V. For the treatment of gastric ulcer rationale of surgical intervention is reviewed. The distal partial gastrectomy of either the Billroth I or Eillroth II tyre as a method of choice and vagotomy coupled with either antrectomy or a drainage procedure as an alternative are mentioned.
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KEYWORD
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