Chapter 39: UGI Bleed- Types of Surgeries

Question 1

Graham patch

Answer 1

Place viable omentum over perforation and tack into place with sutures

Question 2

Truncal vagotomy

Answer 2

Resection of a 1- to 2-cm segment of each vagal trunk as it enters the abdomen on the distal esophagus, decreasing gastric acid secretion

Question 3

What other procedure must be performed along with a truncal
vagotomy?

Answer 3

“Drainage procedure” (pyloroplasty, antrectomy, or gastrojejunostomy), because vagal fibers provide relaxation of the pylorus, and, if you cut them, the pylorus will not open

Question 4

Vagotomy and pyloroplasty

Answer 4

Pyloroplasty performed with vagotomy to compensate for decreased gastric emptying

Question 5

Vagotomy and antrectomy

Answer 5

Remove antrum and pylorus in addition to vagotomy; reconstruct as a Billroth I or II

Question 6

What is the advantage of proximal gastric vagotomy (highly
selective vagotomy)?

Answer 6

No drainage procedure is needed; vagal fibers to the pylorus are preserved; rate of dumping syndrome is low

Question 7

What is a Billroth I (BI)?

Answer 7

Truncal vagotomy, antrectomy, and gastroduodenostomy

(Think: BI = ONE limb off of the stomach remnant)

Question 8

What are the contraindications for a Billroth I?

Answer 8

Gastric cancer or suspicion of gastric cancer

Question 9

What is a Billroth II (BII)?

Answer 9

Truncal vagotomy, antrectomy, and gastrojejunostomy

(Think: BII = TWO limbs off of the stomach remnant)