SURGICAL MEASURES

Muhammad Ridhwan Jusoh

INTRODUCTION

Since the introduction of new anti H. Pylori and acid suppressing drugs, surgical measures are rare! The only indication for surgery are complications that were induced by the peptic ulcer disease

TYPES OF ! SURGICAL MEASURES

Laparotomy! Partial resection of the GIT! Peritoneal debridement! Highly selective vagotomy

LAPAROTOMY

Uses :!

Exploratory or emergency! Coeliotomy for GIT resection!

Types :!

Full incision laparotomy! Laparoscopy laparotomy

LAPAROTOMY

LAPAROTOMY

Procedure :!

Administer general anaesthesia! Apply antibacterial solution on surgical site! Incision is made at the painful area! Inspection of the abdominal cavity! Biopsies may be taken, lavage may be done! Incision is closed with sutures, staples or glue

LAPAROSCOPY

GIT RESECTION

Resection means removing or cutting out! Indications :!

Ulcers are chronic and non healing! Removing necrotic parts! Treating perforations! Removing malignant mass

GIT RESECTION

Types :!

Gastrectomy! Ileostomy! Jejunostomy! Colectomy! Patch-repair

GIT RESECTION

Gastrectomy :!

Billroth I - The ulcer and ulcer bearing area (pylorus) are removed, and proximal stomach is directly anastomosed with duodenum! Billroth II - Greater curvature anastomosed with jejunum (gastrojejujostomy), stomach antrum is removed! Polya - Modication to Billroth II, 2/3 of the stomach is removed! Roux en-Y - Proximal or distal gastric bypass surgeries

GASTRECTOMY

GASTRECTOMY

ILEOSTOMY & JEJUNOSTOMY

COLECTOMY

COLECTOMY

COLECTOMY

GIT RESECTION

Patch repair :!

Done when there is perforation! Procedure :!

Oversewing of the perforated parts! Part of omentum is taken as put as a patch

PATCH REPAIR

GIT RESECTION

Complications :!

Incisional hernias! Infections, inammations! Diarrhoea! Dumping, small stomach, blind loop syndrome! Iron, Vitamin B12 and folate deciency

PERITONEAL DEBRIDEMENT

Prophylaxis measure to manage infection! Treating peritonitis by removing the necrotic tissues! Lavage may be done

HIGHLY SELECTIVE VAGOTOMY

Truncal vagotomy was once the main treatment for chronic duodenal ulcers! Highly selective vagotomy means denervation of those branches supplying lower oesophagus and stomach (leaving nerve of Laterjet in place)

HIGHLY SELECTIVE VAGOTOMY

HIGHLY SELECTIVE VAGOTOMY

THANK YOU