1. Any patient admitted to a hospital because of peptic ulcer disease should be placed on lifelong acid suppression.
2. Patients who regularly take NSAIDs or aspirin should take concomitant acid suppressive medication if they are more than age 60 years old, or on anticoagulants, or if they have multiple medical comorbidities.
3. Lifelong acid suppressive medication may be equivalent to surgical vagotomy in preventing recurrent peptic ulcer or ulcer complications.
4. Gastric resection for peptic ulcer should be avoided in the asthenic or high-risk patient.
5. Many patients with locally advanced gastric cancer (T2b, T3, T4) are cured by an oncologically sound operation that includes wide margins and adequate lymphadenectomy.
6. Most patients with primary gastric lymphoma can be treated without gastric resection.
7. Gastric carcinoids should usually be removed either endoscopically or surgically. The surgeon should treat gastric carcinoid without hypergastrinemia (type 3) as if it were malignant.
8. Roux-en-Y gastrojejunostomy should be avoided unless more than half of the stomach has been removed. Otherwise marginal ulceration and/or gastric stasis (Roux syndrome) may become problematic.
The stomach is a remarkable organ with important digestive, nutritional,
and endocrine functions. The stomach stores and facilitates the
digestion and absorption of ingested food, and it helps regulate appetite.
Treatable diseases of the stomach are common, and it is accessible
and relatively forgiving. Thus, the stomach is a favorite therapeutic
target. To provide intelligent diagnosis and treatment, the physician
and surgeon must understand gastric anatomy, physiology, and pathophysiology.
This includes a sound understanding of the mechanical, secretory,
and endocrine processes through which the stomach accomplishes its
important functions. It also includes a familiarity with the common
benign and malignant gastric disorders of clinical significance.
The purpose of this chapter is to enhance the reader’s
current understanding and familiarity with these concepts and topics.
Some important milestones in the history of gastric surgery1–6 are
listed in Table 26-1.
26-1 Historic Milestones in Gastric Surgery
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26-1 Historic Milestones in Gastric Surgery
|350 b.c. – 201 a.d.||Existence of gastric ulceration was acknowledged
by Diocles of Carystos (350 b.c.), Celsus, and Galen
|1363||Guy de Chauliac describes closure of gastric wound.|
|1586||Marcellus Donatus of Mantua describes gastric ulcer at autopsy.|
|1600–1700||Reports of surgeons cutting stomach to remove foreign bodies.|
|1688||Muralto describes duodenal ulcer at autopsy.|
|1737||Morgagni describes both gastric and duodenal
ulcer at autopsy.|
|1833||William Beaumont reports data recorded during his care of
Alexis St. Martin who developed a gastric fistula from a left upper
quadrant musket wound.|
|1869||Maury reportedly performs feeding gastrostomy
to palliate esophageal stricture following consultation with Samuel
|1875||Sidney Jones in London publishes the first
successful gastrostomy for feeding.|
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