Stomach Disorders: Surgical Interventions Flashcards
What are the 6 surgical interventions for peptic ulcer disease and gastric cancer?
- Total gastrectomy
- Vagotomy
- Gastric Resection (antrectomy)
- Billroth I (Gastroduodenostomy)
- Billroth II (Gastrojejunostomy)
- Pyloroplasty
What is pyloroplasty?
- Pyloroplasty is surgery to widen the pylorus.
- Involves cutting through and removing some of the pyloric sphincter to widen and relax the pylorus.
- This makes it easier for food to pass into the duodenum.
- In some cases, the pyloric sphincter is entirely removed
What are some conditions that precipitate pyloroplasty?
- Pyloric stenosis
- Peptic ulcers and peptic ulcer disease
- Gastroparesis, or delayed stomach emptying
- Vagus nerve damage or disease
What are the two ways pyloroplasty can be performed?
- Open surgery
- Laparoscopic surgery
Describe an open pyloroplasty.
- A longitudinal incision is made along the pylorus
- Make several small cuts through the muscle of the pylorus sphincter muscles, widening the pyloric opening.
- Stitch the pyloric muscles back transversely
What gastric function does the vagus nerve serve?
• Vagus nerve fibers from the medulla stimulate the parasympathetic nervous system of the stomach which, in turn, stimulates gastric secretion
What is a vagotomy?
• A surgical operation in which one or more branches of the vagus nerve are cut, typically to reduce the rate of gastric secretion
What is a truncal vagotomy?
- This procedure cuts out part of the vagus nerve at the gastroesophageal junction
- After this surgery, the stomach won’t have nerve supply, which can reduce gastric acid to about 50%
How does the vagus nerve affect gastric motility and how is it affected by a vagotomy?
- Gastric motility is regulated through the vagus nerve
- After vagotomy the stomach becomes atonic and hypomotile
- The small intestine also receives its parasympathetic nerve supply through the vagus and vagal stimulation can cause increased motility of the small intestine.
What is a selective vagotomy?
• More precise than truncal vagotomy
• Only the part of the nerve that goes to the stomach is removed, and the vagus nerve connection to the gallbladder and intestine is left in place
o Gastric branches severed, hepatic branches preserved
What is a highly selective vagotomy?
- This procedure is also called parietal cell vagotomy and is the most precise option.
- It involves removing part of the vagus nerve only where it connects with the parietal cells in the stomach wall that release gastric acid.
- The rest of the nerve is left there where it can still stimulate the pyloric valve
What is an anastomosis?
• A connection made surgically between adjacent blood vessels, parts of the intestine, or other channels of the body, or the operation in which this is constructed.
What is a Billroth I procedure?
• The partial gastrectomy is performed with anastomosis to the duodenum
What is a Billroth II procedure?
- The partial gastrectomy is performed with anastomosis to the jejunum
- Former site of pyloric sphincter at duodenum is sewn shut
A billroth I is also called a…
• Gastroduodenostomy
A billroth II is also called a…
• Gastrojejunostomy
Explain a total gastrectomy procedure.
- The stomach and pylorus removed with anastomosis to the jejunum
- Duodenal stump is sewn shut
What is the Roux-en-Y procedure?
- Total gastrectomy procedure with an adjustment to jejunum/duodenal junction
- Former site of pyloric sphincter at duodenum is sewn shut
- Duodenum is severed from the jejunum
- Jejunum is attached to esophagus
- Duodenum is re-attached further down the jejunum