Gastric ulcer

Question 1

Antrectomy and Truncal Vagotomy

Answer 1

• Supine, NGT
• Upper Midline incision
• Kocher maneuver
• Enter lesser sac into gastrocolic ligament, divide greater omentum
• ligate right GE near GDA
• Enter gastrohepatic ligament, divide R gastric
• Transect Duodenum and Stomach with 4.5 mm stapling devices.
• Antecolic BII

Truncal Vagaotomy

• Retract left hepatic lobe, divide triangular ligament
• Dissect esophagus circumferentially
• identify anterior and posterior vagus trunks
• Clip prox and distal 2 cm apart and send to pathology for confirmation.
• Make sure crura is close