In the article, we consider surgery for gastric ulcer.
This pathology occurs due to a destructive change in the mucous layer of this organ, which is in direct contact with food and is the main protective barrier against the overly acidic environment of the contents. In case of destruction of the mucous layer, its protective functions decrease, which eventually leads to an increase and deepening of pathological foci, up to the absolute destruction of the walls of the stomach. That is, thus, a through hole appears, or in another way this phenomenon is also called perforated gastric ulcer. Operations are different.
Pathology treatment
So, do surgery for a stomach ulcer?
A perforated ulcer is treated exclusively by surgery. Preparation for surgery involves the withdrawal of gastric contents along with the restoration of blood pressure. A study of the patient's body is also performed to select further actions.
Options for operations with gastric ulcer
As noted earlier, the only possible treatment option for a perforated ulcer formed in the stomach, which can promise a truly favorable prognosis, is surgery. It is worth emphasizing that the existing measures of conservative therapy allow avoiding a fatal outcome only in isolated cases.
What is the point?
The main point of surgical manipulation is to completely clear the contents of the diseased organ cavity, it is also necessary to clean the abdominal cavity and close the lumen of the perforated opening. In the event that classical suturing of the perforation is not possible, then a resection of the damaged area of the gastric wall is performed. In this case, the following parameters are evaluated before the operation to remove the stomach ulcer:
- The time that has passed since the onset of the disease.
- The nature of the origin of the disease along with the size and localization of the ulcer.
- The general severity of peritonitis and the area of its distribution.
- The age of the patient.
- The presence of additional pathologies in the patient.
- The technical feature of the hospital along with the level of professionalism of doctors.
Currently, doctors carry out organ-preserving surgery (that is, suturing) and radical surgery (in this case we are talking about resections, ulcer excision, etc.).
Sewing a perforated hole
Sewing of the perforated hole is prescribed in the presence of a common form of peritonitis and with high operational risks associated with the presence of concomitant diseases or the patient's age. Also, such an operation of a stomach ulcer can be performed provided that there is no history among young people.
The operation technique in this case consists in excising the edges of the ulcer formation and their subsequent stitching using two rows of sutures. With this method of operation, the shape of the organ is preserved along with the diameter of its lumen. At the end of the operation, temporary drainages are installed. Further treatment with antiulcer drugs is also prescribed.
What other perforated gastric ulcer operations are performed?
Resection
Resection of the stomach is an operation leading to the loss of a significant part of the organ. After its implementation, the patient is diagnosed with a disability. Indications for this operation are the presence of chronic large ulcers in the patient and suspected malignant tumors. Another indication is the patient’s age of less than sixty-five years, provided that there are no comorbidities in the decompression period. Also, this operation can be carried out with the development of acute inflammation and with purulent peritonitis.
In the absence of peritonitis, the perforated hole wall is sutured in combination with proximal vagotomy. Excision of ulcer formation using stem vagotomy and pyroplasty is used in case of pathology in the pyloric section of the stomach, as well as against bleeding and stenosis.
It is important to understand!
The absence of surgery for gastric ulcer will necessarily lead to death in the coming weeks after the development of the disease. But the operation does not guarantee absolute survival. Medical statistics that are responsible for deaths after surgery have shown that after six hours, no more than four percent of patients leave, and after one day no more than forty.
Laser treatment: how is it performed?
Here's how laser stomach treatments for perforated ulcers are currently being conducted:
- A rubber tube is inserted into the patient through the mouth, as is the case with routine diagnostic fibrogastroscopy.
- Further, the doctor through visual observation cauterizes the ulcer wound using a laser beam.
In order to obtain the desired effect of gastric ulcer surgery with a laser, the procedure must be repeated seven to ten times. This is very unpleasant for the patient. But such treatment is quite effective in comparison with conservative methods of therapy, however, it is significantly inferior to surgical operations.
Diet with perforated gastric ulcer is important. About it below.
Consequences and forecast
The lack of timely surgical treatment for perforated gastric ulcers, as a rule, leads to death in ninety-nine percent of cases during the first seven days after perforation. The surgical method makes it possible to reduce this indicator to five to eight percent. It is worth emphasizing that the overall survival of patients in the first couple of hours after surgery is almost one hundred percent, but, unfortunately, this indicator decreases by about a third on the next day.
Regardless of the success of the surgery and the absence of postoperative complications, the quality of life of the patient will regularly suffer due to the disease. First of all, it is required to observe a very strict menu prescribed by a dietitian, which will be based on the individual characteristics of the patient.
The basis of such a diet will always be exclusively easily digestible foods with a low content of raw vegetables and the absolute exception of fried, spicy, sour, salty foods and alcohol, including. Among other things, periodic exacerbations of gastritis are likely, causing the need for drug therapy.
Principles of nutrition after surgery
Rubbed food will be the basis of the diet during the first half year after surgery for a stomach ulcer. The timing of patient recovery directly depends on strict adherence to diet. In order not to overload the digestive organs, the diet should be gradually expanded, changing its composition and methods of cooking. The diet is introduced in stages:
- During the first seven days after surgery, the patient is given exclusively mineral water along with weakly brewed tea and lean broths. At this time, the ingestion of any food, even mashed, can cause complications, because the microflora of the digestive system is almost destroyed. Therefore, the food does not even digest.
- In the second week, already wiped dishes are introduced into the daily menu in the form of cereals boiled in water with a certain amount of milk. Also included are mashed soups cooked from cereals.
- In the third and fourth week, the patient is prescribed a regular rubbed diet. In addition to slimy cereals and mashed soups, the menu contains the maximum chopped vegetables and meat.
- After six months, the menu is supplemented with unpasteful dishes, but the food should still be neutral, that is, from a chemical point of view, without the content of any spices, sugar and salt.
Diet after surgery perforated gastric ulcer must be strictly observed.
Nutrition rules
After surgery, the patient adhere to the following rules:
- Solid foods for about two months should be excluded from the diet. Even a small piece can get into the abdominal cavity, and it will be necessary to do another operation to remove it, since even a probe will not help in this case.
- An ideal meal is one that lacks fast carbohydrates, cholesterol, spices, large chunks and carcinogens. That is, the ingredients of the dish during digestion should not induce the digestive organs to secrete excessive amounts of enzymes.
- The size of one serving should be with a fist. In the event that it turns out to be larger, the stomach simply can not cope with the task, which can cause a relapse.
- You should always take food at the same time. Due to this, the stomach gets used to produce digestive enzymes at a certain time. In addition, it is very important to maintain the same interval between meals. The maximum interval between those should be three hours. If it is smaller, then the organs may not have time to cope with the previous portion. If it turns out to be larger, then self-digestion can be caused. The fact is that against the background of a prolonged lack of food, the stomach still secretes digestive enzymes that corrode its mucosa.
- Should I only cook steamed and is it possible to bake dishes in the first two months after surgery? The answer to these questions is one - undesirable. Even baking food during the first month after surgery is not recommended. Raw fruits and vegetables will also have to be abandoned for at least one to two months.
Not everyone knows what to eat after surgery stomach ulcers.
Grocery list
The rubbed diet is observed for the first three months, and in cases of risk of relapse, you have to adhere to it for six months. Only water-boiled foods are allowed along with slimy cereals and lean soups. All ingredients are crushed before serving in a blender or served as mashed potatoes. During recovery, it is very important that protein dishes prevail in the patient’s menu, since the amino acids found in such foods serve as the main building material for the human body. The permitted products are:
- Mashed vegetable soups with the exception of cabbage soup, as it is digested for a long time. You can also add cereals in soups in the form of rice, buckwheat, millet, barley and so on.
- The use of lean broth from lean meat in the form of chicken, turkey, fish and so on.
- Eating chopped lean meat in the form of meatballs, meatballs and mashed potatoes.
- Soft-boiled eggs are suitable for eating along with steam omelettes.
- The use of non-sour and non-fat milk, sour cream and cream, but the latter can be taken no more than ten grams per day. Non-acidic kefir will also be useful along with fermented baked milk, mild cheese and non-acidic cottage cheese.
- Dried bread baked from wheat flour is also very useful.
- The use of puddings, cheesecakes, lazy dumplings and casseroles, but instead of sugar, you must add honey to these products.
- Eating boiled vegetables in the form of cauliflower, carrots, zucchini, pumpkin, eggplant and potatoes.
- Eating porridges on water from semolina, rice, oatmeal and buckwheat.
desserts
It is permissible for such patients to eat puddings and casseroles made from boiled cereals from desserts (but honey must be added instead of sugar). Also, various mousses, fruit jellies are suitable as desserts. True, such dishes can be consumed no earlier than two months after the operation. Of the drinks, preference should be given to weak tea. It is necessary to completely abandon salt and any spices. It is necessary to refuse also from fancy pastry, pickles, offal and marinades. Smoked, spicy, fried and spicy food along with the use of preservatives is strictly prohibited.
We examined the types of operations and the diet for stomach ulcers.