58 year old gentleman with recurrent abdominal pain, vomiting and weight loss was diagnosed with peptic ulcer disease and gastric outlet obstruction. He was operated and a laparoscopic (minimally invasive surgery) vagotomy and gastrectomy was done. The patient was discharged on 6th postoperative day & is completely cured of his problem since then.
Peptic ulcer disease requiring surgery due to various complications was a very common thing 30 years back. With advances in drugs available to control gastric acid, surgery has got a very little role now. Intermittent patients with acute complications like bleeding and chronic complications like obstruction are handled with endoscopic treatment followed by medicines. However once in a while surgeons will face peptic ulcer disease with complications like bleeding / obstruction which requires a surgery, perforation, cancer and poor response to medical line of treatment. Patient in the case mentioned also falls in this last group and needed a surgery (vagotomy – vagus nerve disconnection) to reduce secretion of acid secretion and a gastrectomy (removal of obstructed part of stomach involved by ulcer and scarring). The gastrointestinal continuity is reestablished by joining proximal small intestine with the remaining stomach. This surgery used to be done through a big incision earlier, however we perform it laparoscopically i.e. key hole surgery. This shortens & smoothens the recovery.
As mentioned earlier cancer may coexist with peptic ulcer disease. Hence it should always be ruled out diligently in all patients by endoscopy and multiple biopsy if needed. Sometimes CT scan is also required as was done in this case. Cancer / malignant ulcer when present will require a radical gastrectomy opposed to a simple gastrectomy for benign ulcer disease. A laparoscopic surgery is feasible in malignancy too, however in selected cases only.