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