Whenever testing suggests Helicobacter pylori infection, treatment should be initiated and eradication confirmed.
Lifelong acid suppression should be considered in any patient admitted to a hospital because of peptic ulcer disease. Acid suppressive medication may be equivalent to surgical vagotomy in preventing recurrent peptic ulcer or ulcer complications.
If possible, gastric resection for peptic ulcer is avoided in the asthenic or high-risk patient.
Though less common in the United States, gastric cancer is a major cause of cancer-related morbidity and mortality worldwide.
Diagnostic laparoscopy with peritoneal lavage should be considered in the evaluation of clinical stage 2 and 3 patients with gastric cancer.
Multimodality therapy for gastric cancer, including resection in combination with perioperative chemotherapy or adjuvant chemoradiotherapy is associated with a survival advantage compared to surgery alone.
Most patients with primary gastric lymphoma can be treated without gastric resection.
Localized gastrointestinal stromal tumors of the stomach are treated with full thickness excision. Adjuvant (or neoadjuvant) imatinib is indicated for higher-risk lesions.
Gastric neuroendocrine tumors may arise in the presence (types 1 and 2) or absence (type 3) of hypergastrinemia. Type 3 gastric neuroendocrine tumors should usually be treated with subtotal gastrectomy and regional lymphadenectomy.
Roux-en-Y gastrojejunostomy with a large (>50%) proximal gastric remnant should be avoided because marginal ulceration and/or gastric stasis (Roux syndrome) may become problematic.
The stomach stores and facilitates the digestion and absorption of ingested food and helps regulate appetite. Treatable diseases of the stomach are common, and it is accessible and relatively forgiving of surgical manipulation. To provide accurate diagnosis and rational treatment, the physician must understand gastric anatomy, physiology, and pathophysiology; this includes a sound understanding of the mechanical, secretory, and endocrine processes by which the stomach accomplishes its important functions and a familiarity with the common benign and malignant gastric disorders. Important historical milestones1–6 that influenced the contemporary understanding of gastric disease and surgical therapy are summarized in Table 26-1.
Table 26-1Historic milestones in gastric surgery |Favorite Table|Download (.pdf) Table 26-1 Historic milestones in gastric surgery
|DATE ||EVENT ||DATE ||EVENT |
350 B.C.– 201 A.D.
Existence of gastric ulceration was acknowledged by Diocles of Carystos (350 B.C.), Celsus, and Galen (131–201 A.D.).
Guy de Chauliac describes closure of gastric wound.
Marcellus Donatus of Mantua describes gastric ulcer at autopsy.
Reports of surgeons cutting stomach to remove foreign bodies.
Muralto describes duodenal ulcer at autopsy.
Morgagni describes both gastric and duodenal ulcer at autopsy.
William Beaumont reports data recorded during his care of Alexis St. Martin who developed a gastric fistula from a left upper quadrant musket wound.
Maury reportedly performs feeding gastrostomy to palliate esophageal stricture following consultation with Samuel D. Gross.
Sidney Jones in London publishes the first successful gastrostomy for feeding.