This document discusses various types of gastric surgeries including gastrectomy, vagotomy, and gastrojejunostomy. It outlines indications for gastric surgery such as complicated peptic ulcers, cancer, and obesity. Complications of gastric surgery are discussed, including early complications like bleeding and leaks, and late complications like stenosis and hernias. Specific procedures for ulcers, cancer, and obesity are described. Complications of vagotomy like diarrhea and dumping syndrome are also summarized.

1. Dr.Prakash Patel
Department of surgery
Government Medical College , Surat

2. Objectives
 To know the various surgeries performed for gastric
pathology .
 To know to basic principle for gastric surgery
 To know the complications of gastric surgery
 To know the management of complications

3. GASTRIC SURGERY
 Common surgeries performed on stomach are:
 Gastrotomy
 Gastrostomy
 Gastrectomy
 Vagotomy, surgeries for peptic ulcers and perforation
 Drainage procedures
 Pyloroplasty
 Gastrojejunostomy
 pyloromyotomy

4. Indications for gastric surgery
 Complicated peptic ulcers
 Surgical management of duodenal ulcers
 Ca.stomach
 Obesity
 Gastro intestinal stromal tumors (GIST)
 Corrosive stricture of stomach
 Zollinger Ellison syndrome

5. Complicated peptic ulcers
 Indications for Surgical procedures
 Refractory to medical management
 Hemorrhage
 Perforation
 Obstructive symptoms

6.  Surgical procedures for complicated peptic ulcer
disease
 Vagotomy with drainage
 Billroth II gastrectomy
 Gastrectomy with hemostasis

7.  Surgery for Ca. stomach
 Radical total gastrectomy
 Radical partial gastrectomy
 Palliative resection
 Bypass

8.  Surgery for Obesity
 Malabsortives types
 Restrictive types
 Gastric band
 Sleeve gastrectomy
 Gastroplasties
 Mixed
 Gastric bypass
 Biliopancreatic diversion with duodenal switch

9. SURGICAL MANAGEMENT OF
DUODENAL ULCERS
 Principles
 Reduce acid secretion by dividing vagus nerve-
vagotomy
 Vagotomy denervate stomach and pylorus which will
lead to gastric outlet obstruction.
 So drainage procedure is performed called as
pyloroplasty.
 Two types of surgical procedures
 Truncal vagotomy with pyloroplasty
 Selective vagotomy with pyloroplasty

10.  Billroth-I
 Remove of distal
part of stomach
and
anastomosis of
stomach
with duodenum.

11.  Billroth II
 Remove distal part of
stomach and perform
gastro – jejunostomy.

12. Roux en Y anastomosis

13. Complications of gastric surgery
 Early
 late

14. Early complications
 Gastrointestinal haemorrhage
 Anastomotic leak
 Pulmonary embolism
 DVT( Deep vein thrombosis)
 Wound infection
 Respiratory insufficiency , pneumonia
 Acute gastroparesis
 Ischemic necrosis of gastric ramnant or anstomotic
site.
 Duodenal stump blow out

15. Late complications
 Stomal stenosis
 Bowel obstruction, small bowel obstruction
 Internal hernia
 Cholelithiasis
 Micronutrient deficiencies
 Marginal ulcer
 Staple line disruption
 Ventral hernia formation
 Post vagotomy diarrhoea

16.  Malabsorption of fat soluble vitamins ( vitamin A, D, E
,K )
 Vitamin A deficiency, which causes night blindness
 Vitamin D deficiency , which causes osteoporosis
 Iron defiiciency
 Protein energy malnutrition
 Afferent loop syndrome
 Blind loop syndrome

17.  Alkaline gastritis
 Stomal ulcers
 Gastrojejunocolic fistula

18. Vagotomy complications
 Decreased acid secretion
 Faster gastric emptying
 Diarrhoea
 Dumping syndrome
 Gastric outlet obstruction

19.  Vagotomy denervates from stomach to distal
transverse colon including pancreas and gall bladder.
 Gall bladder denervations leads to stasis and which
increase the chance of gall stones
 Decrease in pancreatic and gallbladder secretions
leads to undigested fat steatorrhoea

20.  DUMPING SYNDROME
 Early
 Late
 Cardiovascular and GI symptoms due to vagotomy and
pyloroplasty or gastrectomy
 Early dumping syndrome due to Hypovolemia
 Late dumping syndrome due to Hypoglycemia

21. Complications of gastrectomy
 Anaemia ( intrnsic factor essential for binding of vit
B12 for absorption in terminal ileum)
 Early satiety
 Hypocalcaemia – reduced HCL production interferes
with absorption of calcium and Fe in the duodenum
 Gastric stump carcinoma – due to chronic irritation of
stunp by duodenul secretions

22. Early Dumping Syndrome
 No intact pylorus leads to dumping of large amount of
chymes , billiary and pancreatic secretions in to the
duodenum at once
 Results in large amount of fluid shift
 Occurs within 40 minutes of ingestion
 Symptoms
 Tachycardia
 Diaphoresis
 Palpitations
 Diarrhoea
 Abdominal pain

23. Late Dumping Syndrome
 Due to rebound hypoglycaemia
 Occurs 2-4 hours post op
 Symptoms
 tachycardia
 Palpitations
 Diaphoresis
 Dizziness

24. Afferent Loop Syndrome
 Symptoms show immediately after meal
 Occurs only with billroth II reconstruction.
 Obstruction of afferent loop adjcent to anastomosis.
 Cramping pain
 Vomiting of dark brown bitter tasting material
 Symptoms resolves with vomiting

25. Blind Loop Syndrome
 After Billroth II than roux en y gastrojejunostomy , also
seen after irradiation or morbid obesity
 Associated with bacterial overgrowth in the limb of
intestine excluded from flow of chyme.
 This limb has bacteria which proliferate and interfere with
folate and vit B12 metabolism, also bacterial overgrowth
causes deconjugation of bile salts – steatorrhoea
 vit B12 deficiency lead to megaloblastic anaemia
 Diarrhoea
 Weight loss
 weakness

26. Treatment of Blind Loop
Syndrome
 Antibiotics
 Revison surgery or conversion of Billroth I may be
required for some patients

27. Reccurent Ulcer Disease
 Incomplete vagotomy , posterior vagal trunk or a
branch of this trunk (Criminal nerve of grassi) is left
intact
 Truncal vagotomy + antrectomy ( lowest rate 2%)
 Proximal gastric vagotomy ( highest rate 12%)

28.  Treatment –
 Endoscopy + congo red dye ( to demonstrate area of
pH drop in gastric mucosa )
 PPI(proton Pump Inhibiter) for long term
 Re operative vagotomy
 Recurrent ulceration despite of verified complete
vagotomy  look for endocrine etiology like family
history of MEN I syndrome , also look for
hyperparathyroidism and Gastrinoma as possible
cause.