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SURGICAL MEASURES

Muhammad Ridhwan Jusoh

INTRODUCTION

Since the introduction of new anti H. Pylori and acid suppressing drugs, surgical measures are rare! The only indication for surgery are complications that were induced by the peptic ulcer disease

TYPES OF ! SURGICAL MEASURES • • • • Laparotomy! Partial resection of the GIT! Peritoneal debridement! Highly selective vagotomy .

LAPAROTOMY • Uses :! • • Exploratory or emergency! Coeliotomy for GIT resection! • Types :! • • Full incision laparotomy! Laparoscopy laparotomy .

LAPAROTOMY .

lavage may be done! Incision is closed with sutures. staples or glue .LAPAROTOMY • Procedure :! • • • • • • Administer general anaesthesia! Apply antibacterial solution on surgical site! Incision is made at the painful area! Inspection of the abdominal cavity! Biopsies may be taken.

LAPAROSCOPY .

GIT RESECTION • • ‘Resection’ means ‘removing’ or ‘cutting out’! Indications :! • • • • Ulcers are chronic and non healing! Removing necrotic parts! Treating perforations! Removing malignant mass .

GIT RESECTION • Types :! • • • • • Gastrectomy! Ileostomy! Jejunostomy! Colectomy! Patch-repair .

and proximal stomach is directly anastomosed with duodenum! Billroth II . 2/3 of the stomach is removed! Roux en-Y .Proximal or distal gastric bypass surgeries • • • .Greater curvature anastomosed with jejunum (gastrojejujostomy).The ulcer and ulcer bearing area (pylorus) are removed. stomach antrum is removed! Polya .GIT RESECTION • Gastrectomy :! • Billroth I .Modification to Billroth II.

GASTRECTOMY .

GASTRECTOMY .

ILEOSTOMY & JEJUNOSTOMY .

COLECTOMY .

COLECTOMY .

COLECTOMY .

GIT RESECTION • Patch repair :! • • Done when there is perforation! Procedure :! • • Oversewing of the perforated parts! Part of omentum is taken as put as a patch .

PATCH REPAIR .

blind loop syndrome! Iron.GIT RESECTION • Complications :! • • • • • Incisional hernias! Infections. inflammations! Diarrhoea! Dumping. Vitamin B12 and folate deficiency . small stomach.

PERITONEAL DEBRIDEMENT • Prophylaxis measure to manage infection! Treating peritonitis by removing the necrotic tissues! Lavage may be done • • .

HIGHLY SELECTIVE VAGOTOMY • Truncal vagotomy was once the main treatment for chronic duodenal ulcers! Highly selective vagotomy means denervation of those branches supplying lower oesophagus and stomach (leaving nerve of Laterjet in place) • .

HIGHLY SELECTIVE VAGOTOMY .

HIGHLY SELECTIVE VAGOTOMY .

THANK YOU .