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KEY POINTS

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  1. Any patient admitted to a hospital because of peptic ulcer disease should be considered for lifelong acid suppression.

  2. Lifelong acid suppressive medication may be equivalent to surgical vagotomy in preventing recurrent peptic ulcer or ulcer complications.

  3. 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.

  4. Gastric resection for peptic ulcer should be avoided in the asthenic or high-risk patient, if possible.

  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 III) as if it were malignant.

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INTRODUCTION

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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; and a familiarity with the common benign and malignant gastric disorders of clinical significance. The surgeon must also understand the indications, complications, and outcomes of procedures utilized to treat diseases of the stomach. 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 surgery1,2,3,4,5,6 are listed in Table 26-1.

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Table Graphic Jump Location
Table 26-1Historic milestones in gastric surgery

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