In the article, we will consider the operation for a stomach 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, in this way, a through hole appears, or in another way this phenomenon is also called a perforated stomach ulcer. Operations vary.
Treatment of pathology
So, do they do surgery for stomach ulcers?
A perforated ulcer is treated exclusively by surgery. Preparation for surgery involves the removal of gastric contents along with the restoration of blood pressure. They also conduct a study of the patient's bodyto select further actions.
Surgery options for gastric ulcer
As noted earlier, the only possible treatment option for a perforated ulcer that has formed in the stomach, which can promise a truly favorable prognosis, is surgery. It is worth emphasizing that the existing measures of conservative therapy make it possible to avoid death only in isolated cases.
What's the point?
The main point of the surgical manipulation is to completely clean the cavity of the diseased organ from the contents, it is also necessary to clean the abdominal cavity and close the lumen of the perforated hole. In the event that the classic suturing of the perforation is not possible, then resection of the damaged area of the gastric wall is performed. In this case, before the operation to remove the stomach ulcer, the following parameters are evaluated:
- 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.
- General severity of peritonitis and area of its distribution.
- Age of the patient.
- The patient has additional pathologies.
- Technical feature of the hospital along with the level of professionalism of doctors.
Currently, doctors perform organ-preserving surgery (that is, closure) and radical operations (in this case, we are talking about resections, excision of an ulcer, etc.).
Suturing a perforated hole
Suturing a perforated hole is prescribed in the presence of a common form of peritonitis and at high operational risks associated with the presence of concomitant diseases or the age of the patient. Also, such an operation on a stomach ulcer can be performed provided that there is no history among young people.
The technique of the operation 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. Upon completion of the operation, temporary drains are installed. Further anti-ulcer therapy is also prescribed.
What other surgeries are performed on a perforated stomach ulcer?
Performing resection
Resection of the stomach is an operation that leads to the loss of a significant part of the organ. After its implementation, the patient is given a disability. The indications for this operation are the presence of chronic large-diameter ulcers in the patient and suspicions of malignant tumors. Another indication is the age of the patient less than sixty-five years, provided there are no concomitant diseases in the decompensation period. Also, this operation can be performed with the development of acute inflammation and against the background of purulent peritonitis.
In the absence of peritonitis, the wall of the perforated hole is sutured in combination with proximal vagotomy. Excision of an ulcer formation using stem vagotomy and pyroplasty is used in case of pathology in the pyloric part of the stomach, as well asagainst the background of bleeding and stenosis.
Important to understand
The lack of surgery for gastric ulcers will inevitably lead to death in the coming weeks after the onset of the disease. But the operation does not guarantee absolute survival. Medical statistics responsible for deaths after surgery show 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?
This is how gastric laser treatment for perforated ulcers is currently done:
- A rubber tube is inserted through the patient's mouth, as is done in conventional diagnostic fibrogastroscopy.
- Next, the doctor, through visual observation, cauterizes the ulcer with a laser beam.
In order to obtain the desired effect from laser gastric ulcer surgery, the procedure must be repeated seven to ten times. This is very unpleasant for the patient. But such treatment is quite effective compared to conservative methods of therapy, however, it is significantly inferior to surgical operations.
Diet for a perforated stomach ulcer is important. More on that below.
Consequences and forecast
The lack of timely surgical treatment of perforated gastric ulcers, as a rule, leads to death of patients in ninety-nine percent of cases within the first seven days after perforation. Surgic althe method makes it possible to reduce this figure to five to eight percent. It is worth emphasizing that the overall survival of patients in the first couple of hours after the operation is almost one hundred percent, but, unfortunately, this figure decreases by about a third the next day.
Regardless of the success of the surgical operation and the absence of postoperative complications, the patient's quality of life will regularly suffer due to the disease. First of all, you need to follow 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 exclusion of fried, spicy, sour, s alty foods and alcohol as well. Among other things, periodic exacerbations of gastritis are likely, causing the need for drug therapy.
Principles of nutrition after surgery
Pureed food will be the basis of the diet during the first six months after surgery for stomach ulcers. The recovery time of the patient directly depends on the strict adherence to the diet. In order not to expose the digestive organs to excessive stress, 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 the operation, the patient is given exclusively mineralwater along with weakly brewed tea and lean broths. At this time, the ingestion of any food, even pureed, can cause complications, because the microflora of the digestive system is almost destroyed. Therefore, the food will not even be digested.
- In the second week, already pureed dishes are introduced into the daily menu in the form of cereals boiled in water with some milk. Also included are pureed soups cooked from cereals.
- In the third and fourth weeks, the patient is prescribed the usual pureed diet. In addition to slimy cereals and pureed soups, the menu includes the most chopped vegetables and meat.
- After six months, the menu is supplemented with non-mashed dishes, but the food should still be neutral, that is, from a chemical point of view, without containing any spices, sugar and s alt.
The diet after surgery for perforated gastric ulcer must be strictly observed.
Eating Rules
After the operation, the patient must adhere to the following rules:
- Solid food should be eliminated from the diet for about two months. Even a small piece can get into the abdominal cavity, and another operation will be necessary to remove it, since even a probe will not help in this case.
- The ideal dish 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 the size of a fist. ATif it turns out to be more, the stomach simply cannot cope with the task, which can cause a relapse.
- Meals should always be taken at the same time. Thanks to this, the stomach gets used to producing digestive enzymes at a certain time. In addition, it is very important to observe the same interval between meals. The maximum interval between these should be three hours. If it is less, then the organs may not have time to cope with the previous portion. If it turns out to be more, then self-digestion can be caused. The fact is that against the background of a long absence of food, the stomach still secretes digestive enzymes that corrode its mucosa.
- Should only be steamed and can meals be baked in the first two months after surgery? The answer to these questions is undesirable. Even baking food during the first month after the operation is not recommended. Raw fruits and vegetables will also have to be abandoned for at least one or two months.
Not everyone knows what to eat after gastric ulcer surgery.
Product List
The wiped diet is observed during the first three months, and in cases of risk of relapse, it is necessary to adhere to it for six months. It is allowed to eat only foods boiled in water, along with slimy cereals and lean soups. All ingredients are ground before serving in a blender or served as a puree. During recovery, it is very important that the patient's menu is dominated by protein dishes, since those in suchamino acids serve as the main building material for the human body. The allowed products are:
- Pure vegetable soups except cabbage soup as it takes a long time to digest. You can also add cereals in the form of rice, buckwheat, millet, pearl barley and so on to soups.
- Eating lean lean meat broths like chicken, turkey, fish, etc.
- Eating shredded lean meat in the form of patties, meatballs and mashed potatoes.
- Suitable for meals and soft-boiled eggs along with steam omelettes.
- Use non-acidic and low-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.
- Very he althy and dried bread baked from wheat flour.
- Use puddings, cheesecakes, lazy dumplings and casseroles, but instead of sugar, add honey to these products.
- Food boiled vegetables in the form of cauliflower, carrots, zucchini, pumpkin, eggplant and potatoes.
- Food with cereals on the water from semolina, rice, oatmeal and buckwheat.
Desserts
From desserts, such patients are allowed to eat puddings and casseroles made from boiled cereals (but they need to add honey instead of sugar). Also, various mousses, fruit jelly are suitable as desserts. True, such dishes can be consumed no earlier than two months after the operation. Fromdrinks preference should be given to weak tea. It is necessary to completely abandon s alt and any spices. You will also have to refuse pastry, pickles, offal and marinades. Smoked, spicy, fried and spicy foods along with the use of preservatives are strictly prohibited.
We looked at the types of operations and diet for stomach ulcers.
