Laparoscopic stomach surgery

What is surgery for stomach ulcers and peritonitis?

Surgery for peritonitis is to remove any part of your peritoneum that has been seriously damaged by the infection. The ruptured organ may be repaired and the abdominal cavity of blood and pus will be washed out.

Your surgeon will then treat the underlying cause, such as a perforated ulcer. Infected tissue, for example an abscess or a burst appendix, will be surgically removed and the abscess in your peritoneum can be drained with a needle.

Surgery for a bleeding ulcer:

Endoscopy is usually performed. This is a procedure that inserts an endoscope, which is a flexible tube with a camera and light on one end with instruments attached to it, through your mouth into your stomach. This is important to diagnose the bleeding ulcer and administer appropriate treatment to cure the ulcer. The bleeding ulcer can be stopped using a laser during endoscopy. Otherwise, a surgery known as a partial gastrectomy can be performed to remove part of your stomach.

Surgery for a perforated ulcer:

If the ulcer continues to grow so that it creates a hole in your stomach or intestinal wall, this is a perforated ulcer. Your surgeon will usually sew up the hole.

Peptic ulcer surgery:

This provides long-term relief of complications caused by your ulcer. It reduces the buildup of acid within your stomach, such that the formation of ulcers is prevented. Peptic ulcer surgery is usually performed if your ulcers do not heal, there is severe pain in your abdomen, excessive bleeding from the ulcer, obstruction of contents within your stomach and perforated ulcer leading to peritonitis. Peptic ulcer surgery can be done via partial gastrectomy, vagotomy or pyroplasty (see details below).

A laparotomy is a procedure which is performed by surgical incision into your abdominal cavity. It is done to examine your abdominal organs and help your surgeon diagnosed any problems. In many cases, the problem can be treated during laparotomy once it has been identified. In other cases, a second operation may be needed.

Why surgery for bleeding or perforated stomach ulcers?

Ulcers sometimes fail to heal despite treatment and cannot be controlled with medications. In these cases where the ulcer is difficult to heal with other methods of treatment, surgery is recommended to manage your condition.
Why surgery for peritonitis?

Major complications of peritonitis include:

  • sepsis, which is when one or more organs are damaged by the infection or there is a significant reduction of blood supply to your organs and tissues
  • septic shock, which is a dangerously low blood pressure that may lead to failure of vital organs

If left untreated, the infection may enter your bloodstream and this causes shock and may damage your other organs. In many cases of peritonitis, emergency surgery will be performed, especially if peritonitis has been caused by conditions such as a perforated stomach ulcer, appendicitis or diverticulitis. Prompt treatment for perforated ulcers and peritonitis is necessary to avoid potentially severe and fatal complications.

Surgery is the main mode of treatment and management for this life-threatening condition.
What to expect?

Before the procedure

  • Stop all current medications as instructed by your doctor.
  • Consume a healthy diet and take daily walks. This is to increase your endurance and help you recover faster after the surgery.
  • Quit smoking and alcohol at least 24 hours prior to the procedure.
  • You may be give bowel preparation to help you clear your intestines.
  • Fast as instructed.

During the procedure

You will be given anaesthesia to enable you to fall asleep.

A tube will be passed through your nose into your stomach to prevent the accumulation of gastric juices within your stomach. This will be removed only when normal emptying of your stomach has resumed.

A tube drain is placed through your abdominal wall to prevent accumulation of blood or fluid. These tubes will be removed between two to seven days after the surgery.

During laparoscopy, a few incisions are made in your abdomen for the surgeon to operate on your abdomen.

A tiny camera is placed through one of the incisions. Your surgeon watches the video screen in the operating room to view your internal organs. This aids him in using the tools to operate on your abdomen.

Special surgical tools are placed through the other incisions.

Depending on which procedure is the most suitable for you, your surgeon may perform

  • Vagatomy, where he or she selectively cuts one or more of the nerves to your stomach which stimulate acid production.
  • Partial gastrectomy, which removes the part of your stomach that stimulate acid release. This keeps your acid levels down.
  • Pyroplasty, to widen the base of your stomach so stomach contents may pass into it more easily.This can be done for obstructed gastric emptying as a result of inflammation or ulcer scarring.

These procedure may last for around an hour.

After the procedure

  • The nurses will monitor and look after you in the recovery room.
  • You may be discharged within a few days to a week.
  • You may be placed on a liquid diet for the first two to three days. Consume liquid supplements high in nutrition such as Ensure and Ensure Plus. As you heal, gradually add semi-solid purees for the first two weeks and then solid foods back into your diet.
  • Consume frequent, small meals throughout the day.
  • You will feel some pain which can be controlled with painkillers. The level of your pain will decrease over time.
  • You may feel weak and tired for the first few weeks after your surgery which is normal.
  • You will be able to return to daily activities as you recover. This may take four to six weeks.
  • Schedule a follow-up appointment with your doctor for removal of stitches in one to two weeks.