Background Information:

What are the other Names for the Procedure?

• Antrectomy
• Pyloroplasty
• Surgery for Peptic Ulcer

What is the Peptic Ulcer Surgery surgical procedure?

The Peptic Ulcer Surgery is a procedure to reduce the accumulation of acid within the stomach, in order to prevent the formation of ulcers.

What part of the Body does the Procedure involve?

A Peptic Ulcer Surgery involves the esophagus, stomach, duodenum, jejunum, and vagus nerves.

Why is the Peptic Ulcer Surgery surgical procedure Performed?

A Peptic Ulcer Surgery is performed for the following reasons:

• Excessive bleeding from ulcer site
• Excruciating pain in the abdomen
• Obstruction of contents within the stomach
• Ulcer perforation resulting in peritonitis

What are some Alternative Choices for the Procedure?

• The use of laparoscopic procedure (keyhole surgery) is a recent advancement
• Advances in medicines used in anesthesia have decreased the risk of complications

What are the Recent Advances in the Procedure?

Alternatives to Peptic Ulcer Surgery include the use of medications to reduce the acid secretion, along with drugs to fight infection by a type of bacteria called H. pylori, if necessary.

What is the Cost of performing the Peptic Ulcer Surgery surgical procedure?

The cost of Peptic Ulcer Surgery procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding Peptic Ulcer Surgery on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5^th Edition, New York, 2006

http://www.patient.co.uk/doctor/ulcer-surgery-and-its-complications (Accessed on 11/10/2014)

http://heartburn.about.com/cs/articles/a/Ulcer_Surgery.htm (Accessed on 11/10/2014)

Prior to Peptic Ulcer Surgery surgical procedure:

How is the  Peptic Ulcer Surgery surgical procedure Performed?

A Surgery for Peptic Ulcer is generally performed under general anesthesia. Depending on the surgical procedure being performed, the following may be done:

• Vagotomy: The surgeon cuts the vagus nerve (the nerve that transmits messages to increase acid secretion)
• Antrectomy: This involves the removal of the lower portion of the stomach, called the antrum
• Pyloroplasty: This procedure involves enlarging the passage between the stomach and the duodenum (the first portion of the small intestine)

Where is the Procedure Performed?

A Peptic Ulcer Surgery procedure is performed in a hospital.

Who Performs the Procedure?

A general surgeon or a gastrointestinal surgeon performs the Peptic Ulcer Surgery procedure.

How long will the Procedure take?

The time taken depends on the type of Peptic Ulcer Surgery procedure being performed, and it may take up to a few hours.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Peptic Ulcer Surgery procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine, if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Peptic Ulcer Surgery procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Peptic Ulcer Surgery surgical procedure?

Before a Peptic Ulcer Surgery procedure, the patient has to undergo certain tests, such as:

• Routine blood and urine analysis
• Abdominal X-ray
• Endoscopy

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Peptic Ulcer Surgery?
• Why is this procedure necessary?  How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed? 
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Peptic Ulcer Surgery surgical procedure:

What kind of Anesthesia is given, during the Procedure?

General anesthesia by injection and inhalation is administered for the procedure.

How much Blood will you lose, during the Procedure?

There is not much blood loss during an uncomplicated Pyloroplasty procedure.

What are the possible Risks and Complications during the Peptic Ulcer Surgery surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

• Obesity: Generally greater the degree of obesity, greater is the surgical risk
• Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders, chronic infections
• Poor immune system due to a variety of causes

The possible risks or complications that may arise during the Peptic Ulcer Surgery are:

• Excessive bleeding
• Infection in the surgical wound
• Anesthetic complications
• Accidental injury to large blood vessels and surrounding nerves within the neck, top of the lungs, thoracic duct, and laryngeal nerve

What Post-Operative Care is needed at the Healthcare Facility after the Peptic Ulcer Surgery surgical procedure?

At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise. 

After the Peptic Ulcer Surgery surgical procedure:

What are the possible Risks and Complications after the Peptic Ulcer Surgery surgical procedure?

Post Peptic Ulcer Surgery, the following complications may arise:

• Excessive bleeding
• Infection in the surgical wound
• Incisional hernia
• Recurring peptic ulcers
• Excessive diarrhea
• Malnutrition
• The occurrence of symptoms that cause uneasiness, such as flushing, fainting, or diarrhea, after consuming certain foods

What is the Prognosis after the Surgery?

A complete recovery from a Peptic Ulcer surgical procedure is usually achieved, without any serious complications being observed.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Pain that worsens and swelling around the surgical wound
• Bleeding or fluid drainage from the surgical wound
• The occurrence of any symptom that causes uneasiness, such as nausea, vomiting, constipation, abnormal swelling, or excessive rectal bleeding
• Signs of an infection
• Muscle aches, headache
• Dizziness
• Fever, feeling sick
• Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after the Peptic Ulcer Surgery surgical procedure?

At home, the following post-operative care is recommended, after a Peptic Ulcer Surgery:

• Slowly resume regular/daily activities as early as possible, which aids in faster recovery
• Use a heat pad or warm compress to relieve pain due to the incision
• Resume showering and keep the wound clean and dry. Avoid taking baths until the surgical wound is completely healed. Gently wash the surgical wound with unscented soap and re-bandage the wound again
• Complete the course of prescribed medication under advice of the physician
• Take antibiotic medication to help combat or prevent infection (per the physician’s advice)
• Avoid taking nonprescription medications, such as aspirin. However, individuals may take acetaminophen to relieve pain, per the physician’s advise
• Resume driving after 2 weeks, or only when advised by your physician
• Individuals are advised to have clear liquids immediately following surgery, until the gastrointestinal tract begins functioning properly. They are then advised to have a well-balanced diet, which can aid in a faster recovery.

How long does it normally take to fully recover, from the Procedure?

It usually takes about 4-6 weeks to fully recover from a Peptic Ulcer Surgery.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The tissue removed is processed in the laboratory under a pathologist's supervision
• Slide(s) are prepared once the tissue is processed and is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Peptic Ulcer Surgery surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• A hospital
• An anesthesiologist (if anesthesia was administered)
• A pathologist (if the tissue is sent for analysis)
• A general surgeon or gastrointestinal surgeon

The patient is advised to inquire and confirm the type of billing, before the Peptic Ulcer Surgery procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA