Peptic Ulcer Disease – Part 7
Peptic ulcers can either be duodenal ulcers or gastric (stomach) ulcers. There are four types of gastric ulcers. Type 1 gastric ulcers occur on the lesser curvature of the stomach where the inner oblique muscle of the stomach is absent. This point is usually at or close to the incisura and is marked by the junction of the antral and parietal mucosa. Type 1 gastric ulcers usually have normal acid secretion.
There are several options for surgical resection of this ulcer if it is refractory (does not respond to) medical treatment. The most definitive is a Billroth I resection. Some surgeons feel it is not necessary to do a truncal vagotomy (cutting the vagus nerve as it enters the abdominal cavity on either side of the esophagus) as it does not confer added benefit. The recurrence rate with this procedure is around 3%.
A second surgical option is to perform a wedge resection of the ulcer with a parietal cell vagotomy (i.e., highly selective vagotomy) that spars the vagus nerve running to the antrum and pylorus of the stomach. This procedure is associated with a higher recurrence rate and can be technically difficult to perform.
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