3. endoscopic therapy for a stomach ulcer
The less invasive endoscopic therapy (gastrointestinal endoscopy) used for complications of gastrointestinal ulcers is less stressful for the patient than open abdominal surgery. In the case of a bleeding ulcer, for example, a small cannula inserted through the endoscope can be used to inject drugs such as adrenaline into the ulcer. The adrenaline constricts the vessels near the ulcer and thus stops the bleeding.
Fibrin glue or certain resins are also used to glue and compress bleeding vessels. In the case of complications of gastric outlet stenosis, a probe (thin tubular instrument) is advanced through the endoscope (movable tube camera) up to the narrowing. At the end of this probe is a balloon, which is then slowly filled with air or water, thus carefully stretching the stomach lining. With this method, the constriction can be gently stretched in several sessions, thus avoiding open surgery. With this method of stomach ulcer therapy, however, there is always the risk of a tear in the stomach lining, which then leads directly to open surgery.
4. surgical therapy
Today, the importance of surgical treatment of ulcers/pigastric ulcers is very low, as drug therapy has become very efficient over the last decades. Only in the case of gastric or intestinal perforation (ulcer perforation) by the ulcer is there an absolute necessity for surgical suturing of the ulcer. In most cases, a bleeding ulcer can be well sutured endoscopically.
Only rarely does an endoscopically insatiable ulcer bleeding lead to open surgery. Even the narrowing of the stomach outlet (hourglass stomach) can be removed openly by surgery if the endoscopic therapy has failed. Surgical techniques of different ulcer localization Ulcus ventriculi (peptic ulcer)In case of a treatment-refractory peptic ulcer, there is an indication for a 2/3 gastric removal (resection) according to Billroth I or Billroth II, which is usually performed in combination with a vagotomy.In these surgical techniques, parts of the stomach are removed, depending on the location of the ulcer, and the remaining stomach is sutured to the intestine in various ways (anastomosis).
It is important to remove parts of the antrum and corpus because this is where the document cells and sometimes also the G cells are located, which are crucial for acid production. The vagotomy is very important in such cases, because despite the operation, recurrent ulcers (recurrent ulcers) can occur in the further course of the intestine and the vagotomy (see above) reduces the production of gastric acid even more. Gastrointestinal perforationGastrointestinal perforation is the only absolutely necessary indication for surgery in ulcer disease and the most serious complication apart from injecting ulcer bleeding.
In an open operation the ulcer is sutured over. Occasionally, the operation can also be performed by means of laparoscopy. This means that various surgical tools and a camera are inserted through narrow incisions in the abdominal wall. In this way, the ulcer defect can also be sutured.
