Types of operations, indications to them, the pros and cons of surgical intervention in the stomach ulcer and duodenum.
Currently, physicians prefer conservative methods for treating ulcers of the stomach and duodenum. This is due to the risk of developing postoperative complications, known as gastric ulcer disease.
Resection of the stomach is considered a well-developed operation, it is performed by many surgeons, if it allows the presence of appropriate equipment in hospitals.
But now there is a great experience of treating peptic ulcer with different methods. Many clinicians have come to the conclusion that if there is at least a minimum probability of disease-invasive treatment method, even though it will require more time, the patient should be treated with conservative methods. This is due to the fact that many patients after surgery developed state, much oslozhnyavshye their lives, caused a number of everyday inconveniences that provoked the development of anemia - and they nazvaliboleznyami operated stomach. Therefore, it is believed that the skill of a surgeon in a large part depends not only on professional qualities, but also on the correct selection of patients for surgical treatment.
Indications for surgical treatment of peptic ulcer.
One of the most important indications for surgical treatment of ulcers yezloyakisne degeneration, though quite often difficult to determine whether this is a slowly emerging ozlokachestvlenye primary malignant tumor.
Of course, the widespread introduction of the oncomarkers into medical practice has allowed early detection of such patients, but this method does not have 100% confidence. Therefore, the data of other survey methods is extremely important. They allow the surgeon not only to make the correct diagnosis and assign the appropriate type of operation, but also to predict its outcome.
It also has a significance to the detection of metastatic lesions, especially the distant ones - in the supraclavicular lymph nodes, in the lungs, liver, and bones. Therefore, the presence of ulcers with the involvement of the process of other organs and lymph nodes is always a surgeon's alertness, and in many cases makes it necessary to abandon the operation, especially if the ascites begin to form (accumulation of fluid in the abdominal cavity). Endoscopic laparoscopy sometimes helps to detect metastasis, germinal wall germinal tumors, and in some cases to clarify the nature of the expressed pain syndrome.
Patients with distant metastases are usually recognized as neo-hyperbolic, only for vital signs they undergo urgent surgical intervention: perforation or penetration of malignant ulcer, bleeding, rapidly progressing cicatricial stenosis of the original stomach.
If it is noted that the combination of peptic ulcer and gastric polyposis, especially in the presence of multiple polyps, is desirable for resection, since polyposis is very often accompanied by an ulcer and malignant tumor with progression.
In cases where patients often have an acute peptic ulcer disease, with severe and long-lasting acute exacerbations, poorly exposed to conservative therapy, with progressive deterioration of the general condition of the patient, surgical treatment is the best solution to this problem. If there are complications, surgical intervention is the only way to treat the patient.
Surgical treatment of gastric ulcer and duodenal ulcer involves not only the excision of the ulcer, but also eliminate the violation perystaltycheskoy and evacuation function of the stomach, manifested persistent localized spasms and delayed gastric emptying (stenosis). In addition, due to increased activity of the parasympathetic nervous system (vagus nerve), there is a permanent and uncontrolled (regardless of food intake) increased gastric secretion. The solution to these problems is also the purpose of the operation.
Types of operations on the stomach and postoperative syndromes
If the surgeon does not take into account the need for a comprehensive solution to all these problems, there is a high probability of relapse of the ulcer in the stomach, as well as the development of severe postoperative syndromes. But, unfortunately, and now it is often necessary to meet with patients who had one of the following types of surgery.
Local excision of the ulcer. This operation does not solve the problems of the entire stomach, but is only a removal of the investigation, which in the future can lead to a repeated ulceration of the stomach. In the area of the suture often formed a rough cicatricial deformation that disturbs the emptying of the stomach. In such cases, such patients have to undergo repeated surgery.
operation pyloroplasty used in the localization of ulcers in the initial part of the stomach (antral, pyloric and prepylorycheskyy Division), as a result of rumen process, the patient developed stenosis, in this context, sharp stomach pereroztyahuvatysya corroded and the contents of the stomach wall, started the ignition. To eliminate this condition broke the goalie so that food for a long time did not stay in the stomach. But at present, this operation is only used as an additional component during surgery for ulcers.
The operation of vagotomy was in the intersection of the branches of the vagus nerve, in connection with which the secretion of gastric contents was violated, its acidity dropped. But this operation further contributed to the violation of metabolic processes not only in the wall of the stomach, but also the neighboring organs.
Creation of gastrointestinal anastomoses - gastroenterostomy and gastroenteroanastomosis. The purpose of these operations is faster defecation of the stomach, as well as partial neutralization of the gastric contents thrown from the intestine with alkaline digestive juice. In half of these cases, these operations brought not only a significant improvement in well-being, but also led to a complete recovery of patients, especially in the stenting of the original stomach as a result of his scar-ulcer deformation. But in some cases, the patient's condition worsened, as this operation did not eliminate the causes of peptic ulcer, but only eliminated the consequences. In addition, ulcers recurred or developed ulcerative anastomositis again, which only aggravated the patient's condition.
The resection of the stomach was one of the most successful (in 90% of cases) types of surgery, since at the same time not only decreased the increased secretion in the stomach, but also eliminated the ulcer itself, which led to the treatment of patients, despite the fact that the resection surgery itself - quite traumatic and after it nevertheless there are postrezektionnye syndromes.
An important factor influencing the decision on surgical intervention is the localization of the ulcer - in the stomach or duodenum. The fact is that even with the prolonged existing and relapsing duodenal ulcer, it is possible to select for a long time the optimal treatment of peptic ulcer, while the stomach ulcer has a fairly high probability of a malignant tumor, so one should not refuse surgical treatment without the benefit of conservative therapy.