Highly Selective Vagotomy With Duodenal Dilatation In Patients With Duodenal Ulceration And Gastric Outlet Obstruction
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Highly selective drainage
When pyloric stenosis is secondary to duodenal stenosis develops, the stomach compensates for the ulcerationtheadjective'pyloric'is notquiteaccurate, obstructionat its outlet bymeansofhypertrophyof because in most patients the actual site ofnarrow- its muscular wall and by forceful peristalsis in the ing is beyond the pylorus in the first part
Truncal Vagotomy for Peptic Pyloric Stenosis and Assessment
area 13.Endoscopic balloon dilatation has been proposed as an alternative to surgical treatment. However, 50% of patients treated with balloon dilatation remained with recurrent ulceration or outlet obstruction at 3 years. 14-15 Even though ulcer recurrence after TV-Gastrojejunostomy is about 10%, 16
A CLINICAL STUDY IN GASTRIC OUTLET OBSTRUCTION
5. A gastric residue of more than 500 ml in an adult. 6. An aspirate of more than 400 ml on saline load test. 7. Delayed emptying of stomach on barium meal studies. 8. Demonstration at operation of a grossly narrowed gastric outlet. Cicatrised DU was the most common cause of gastric outlet obstruction, but
Partial or Complete Circular Duodenectomy With Highly
Partial duodenectomy and highly selective vagotomy. P indicates level of pylorus. P Figure 2. Complete circular duodenectomy and highly selective vagotomy. P indicates level of pylorus. PATIENTS AND METHODS Eighteen consecutive patients with severe obstructing duo-denal ulcer disease were studied. Severe obstructing dis-
Proton pump inhibition is a feasible primary alter- native to
8. Johnston D, Lyndon PJ, Smith RB, Humphrey CS. Highly selective vagotomy without drainage procedure in the treatment of haemorrhage, perforation and pyloric stenosis due to peptic ulcer. Br J Surg1973; 60: 790 7. 9. Weiland D, Dunn DH, Humphrey EW, Schwartz ML. Gastric outlet obstruction in peptic ulcer disease: an indication for surgery.
Surgical treatment of peptic ulcer disease: current
selective vagotomy (SV) and antrectomy. They found the first and third procedures significantly better and they recommend HSV and gastrojejunostomy as the treatment of choice for patients with duodenal ulcer and gastric outlet obstruction . In summary, the surgical treatment of outlet gastric obstruction due to peptic ulcer disease
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3. Obstruction Gastric outlet obstruction is manifested by delayed gastric emptying, anorexia, nausea and vomiting. Patients are dehydrated+ hypochloremic, hypokalemic metabolic alkalosis. Fluid resuscitation( replacement of chloride and potassium deficiencies)+ nasogastric suction to relieve obstructed stomach.