Northwestern Handbook of Surgical Procedures by Dixon B. Kaufman

By Dixon B. Kaufman


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1. Truncal vagotomy. Step 8. Incise the anterior stomach and duodenum at least 2 cm proximally and distally from the pylorus along the long axis of the bowel. Include perforation in the incision when present. Step 9. Close resultant defect along transverse axis of the bowel. Postop Nasogastric suction until evidence of bowel function. Complications Subhepatic abscess, wound infection, gastric atony, dehiscence of pyloroplasty, esophageal perforation. Follow-Up Assessment of gastric function, ulcer recurrence.

The peritoneum is divided medially to also expose the common hepatic artery. Once the common bile duct and the common hepatic artery have been identified, vessel loops are placed around these structures. The bile duct is retracted laterally and the hepatic artery retracted medially. The soft tissues between the common hepatic artery and the common bile duct are dissected toward the main bile duct. The portal vein is identified posteriorly and dissected free of the bile duct. In cases of malignant strictures, the relationship of the proximal bile duct and tumor to the portal vein and hepatic artery branches is inspected.

Internal hernias may occur through the mesocolon after retrocolic reconstruction. Occasionally, patients may develop bile reflux gastritis or afferent loop syndrome. Recurrent ulcer is very rare. Finally, an aberrant left hepatic artery arising from the left gastric artery may be divided if it is not recognized when dividing the lesser omentum. This may cause ischemia or necrosis of the left hepatic lobe. Gastrointestinal—Gastrectomy: Subtotal or Partial 21 Follow-Up Patients should be seen two or three times in the early postoperative period.

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