The document discusses potential complications from peptic ulcer surgery including recurrent ulceration, small stomach syndrome, bile vomiting, dumping syndromes, post vagotomy diarrhea, and malignant transformation. It provides details on the incidence of recurrent ulcers from different surgical procedures and risk factors. Complications from recurrent ulcers like bleeding, perforation and gastrojejunocolic fistula are also summarized. Treatment approaches for various complications like bile vomiting, dumping syndromes and post vagotomy diarrhea are highlighted.

1. PEPTIC ULCER SURGERY

2. COMPLICATIONS
 RECURRENT ULCERATION
 SMALL STOMACH SYNDROME
 BILE VOMITING
 DUMPING SYNDROMES
 EARLY
 LATE
 POST VAGOTOMY DIARRHOEA
 MALIGNANT TRANSFORMATION
 NUTRITIONAL CONSEQUENCES
 GALLSTONES

3. RECURRENT ULCERATION
 INCIDENCE OF RECURRENCE
OPERATION INCIDENCE
GASTRECTOMY 1-4
GASTRECTOMY ALONE 50
TRUNCAL 2-7
VAGOTOMY+DRAINAGE
SELECTIVE VAGOTOMY 5-10
+DRAINAGE
HIGHLY SEL.VAGOTOMY 2-10
T.V&ANTRECTOMY 1

4. REC. ULCERATION….
 SITE
 HSV - 1ST PART OF DUODENUM
 GJ - AT ANASTOMOSIS ON JEJUNAL SIDE
 (JEJUNAL MUCOSA MORE SENSITIVE TO ACID
DIGESTION)
 GASTRECTOMY - JEJUNAL SIDE OF THE STOMA
 MC PRESENTING SYMPTOM - PAIN
 RISK FACTORS
 TECHNICALLY INADEQUATE OPERATION
 CIGARATE SMOKING
 REFRACTORY ULCERS BEFORE OPERATION

5. REC. ULCERATION…
 COMLICATIONS
 BLEEDING
 PERFORATION
 GASTROJEJUNOCOLIC FISTULA
 ANASTOMOTIC ULCER PENETRATES INTO TRANSVERSE
COLON
 SYMPTOMS
 SEVERE DIARRHOEA AFTER EVERY MEAL
 FOUL BREATH &MAY VOMIT FORMED FECES
 NUTRITIONAL DISTUBANCES(DUE TO SEVERE
CONTAMINATION OF JEJUNUM WITH COLONIC BACTERIA
 INVESDTIGATIONS - BARIUM ENEMA,CT SCAN , ENDOSCOPY ,
BARIUM MEAL
 TREATEMENT -CORRECTION OF DEHYDRATION & ,
MALNUTRITION,REVISIONAL SURGERY

6. SMALL STOMACH SYNDROME
 EARLY SATIETY DUE REDUCTION IN THE SIZE OF
STOMACH
 IN HIGHLY SELECTIVE VAGOTOMY -- LOSS OF
RECEPTIVE RELAXATION
 IMPOOVES WITH TIME
 NO NEED OF REVISIONAL SURGERY

7. BILE VOMITING
 AFTER ANY FORM OF VAGOTOMY WITH
DRAINAGE OR GASTRECTOMY
 EATING PRECIPITATES PAIN &REFLUX SYMPTOMS
 VOMITS A MIXTURE OF FOOD & BILE OR SOME
TIMES BILE ALONE AFTER MEAL
 TREATEMENT
 REVISIONAL SURGERY
 GASTRECTOMY - ROUX-EN Y DIVERSION
 GJ – TAKEN DOWN & SMALL PYLOROPLASTY IS DONE
 PYLOROPLASTY – ANTRECTOMY & ROUX-EN-Y
RECONSTRUCTION

8. EARLY DUMPING
 INCIDENCE IN10% OF PTS. FOLLOWING
GASTRECTOMYOR VAGOTOMY&DRAINAGE AND
RARELY FOLLOWING HSV
 SYMPTOMS – ABDOMINAL&VASOMOTOR
 MECHANISM
 SMALL BOWEL IS FILLED WITH FOOD STUFFS
FROM STOMACH WHICH HAVE HIGH OSMOTIC
LOAD
 LEADS TO SEQUESTRATION OF FLUID FROM
CIRCULATION INTO GIT

9. LATE DUMPING
 INCIDENCE 5%
 REACTIVE HYPOGLYCEMIA
 MECHANISM - CARBOHYDRATE LOAD IN
STOMACH CAUSES HYPERGLYCEMIA WHICH
INTURN RISES INSULINLEVELS RESULTING IN
SECONDARY HYPOGLYCEMIA

10. FEATURES OF EARLY&LATE DUMPING
FEATURE EARLY LATE
INCIDENCE 5-10% 5%
RELATION TO MEALS ALMOST IMMEDIATE SECOND HOUR AFTER
MEAL
DURATION 30-40 MIN 30-40 MIN
RELIEF LYING DOWN FOOD
AGGRAVATEDBY MORE FOOD EXCERCISE
PRECIPITATING FOOD ,ESPECIALLY AS EARLY DUMPING
FACTOR CARBOHYDRATE
RICH&WET
MAJOR SYMPTOMS EPIGASTRIC FULLNESS, TREMOUR,FAINTNESS,
SWETTING, PROSTRATION
LIGHTHEADEDNESS,
TACHYCARDIA,COLIC,
SOMETIMES
DIARRHOEA

11. TREATMENT OF DUMPING SYNDROMES
 SAME FOR BOTH EARLY & LATE
 DIETARY MANIPULATION SMALL DRY
MEALS,AVOID FLUIDS WITH HIGH
CARBOHYDRATE CONTENT
 SOMASTATIN ANALOGUE OCTREOTIDE BEFORE
MEALS
 REVISIONAL SURGERY
 GJ – DRAINAGE IS TAKEN DOWN
 PYLOROPLASTY – REPAIRGASTRECTOMY -
ANTRERCTOMY&ROUX-EN-Y RECONSTRUCTION

12. POST VAGOTOMY DIARHOEA

13. EARLY DUMPING…
 TREATMENT