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Published online by Cambridge University Press: 12 January 2010
Gastric procedures performed with the patient under general anesthesia include those done for complications of peptic ulcer disease (parietal cell vagotomy (PCV), vagotomy and pyloroplasty (VP), vagotomy and antrectomy (VA), hemigastrectomy alone); for benign neoplasms (proximal or distal gastrectomy); and for malignant neoplasms (extended subtotal or total gastrectomy). In the laparoscopic surgery era, antireflux procedures involving the fundus of the stomach and antiobesity procedures including gastric bypass or banding are commonly performed.
While open or laparoscopic PCV or denervation of the fundus and body of the stomach (parietal cell area) is rarely performed currently, open or laparoscopic VP and VA are still occasionally necessary for patients with life-threatening complications of duodenal ulcers – hemorrhage, perforation, or obstruction. Such patients usually have untreated Helicobacter pylori infections or a virulent ulcer diathesis of unknown cause. VP and VA involve cutting the vagal nerve trunks at the esophageal hiatus and rearranging or resecting the pylorus. With antrectomy, all the gastrin-secreting cells are removed as well and reanastomosis to the duodenum (Billroth I) or jejunum (Billroth II) is necessary. Preoperative decompression of the stomach for 5 to 7 days and antibiotic irrigation the night before operation is indicated in patients with gastric dilation from pyloric obstruction. Hemigastrectomy (removal of the ulcer and the distal stomach) is 96% curative for patients with uncomplicated and complicated gastric ulcers and 100% curative for those with benign tumors (leiomyomas).
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