Peptic Ulcer Disease V: Surgical Management and Nursing Care

Vagotomy reduces gastric acid secretion by transecting a portion of the vagus nerve. It may be performed with or without pyloroplasty to improve gastric emptying. While effective, vagotomy frequency has declined due to advances in acid-suppressing medications that offer less invasive alternatives for managing peptic ulcer disease.

Billroth I, or gastroduodenostomy, anastomoses the remaining stomach directly to the duodenum after partial gastrectomy. Billroth II, or gastrojejunostomy, connects the stomach to the jejunum instead. Both restore digestive tract continuity but differ in anatomical reconstruction and are now less commonly performed due to advances in medical therapy.

Antrectomy is the excision of the distal third of the stomach to eliminate the source of acid production. It may be performed alone or as part of subtotal gastrectomy, which removes both the middle and distal thirds. After excision, the remaining stomach is anastomosed to either the duodenum or jejunum to restore digestive continuity.

Acute phase nursing care includes monitoring vital signs, maintaining NPO status to rest the stomach, administering IV fluids and analgesics, using a nasogastric tube for gastric decompression, and recording intake and output. These interventions ensure patient comfort, maintain hydration, and support recovery while preventing complications during the critical postoperative period.

Nurses should watch for abdominal pain, hematemesis, and fever, which may indicate anastomotic leak, hemorrhage, or infection. Early ambulation helps prevent pulmonary embolism, and regular inspection of the surgical site for redness detects infection signs. Vigilant monitoring enables prompt intervention and prevents serious postoperative complications.

Patients should avoid over-the-counter drugs, alcohol, and smoking, all of which exacerbate peptic ulcer disease. Encourage meals at regular intervals in a relaxed environment to aid digestion and reduce stomach stress. Stress management techniques like biofeedback and regular follow-up visits with healthcare providers support recovery and prevent recurrence.

Pyloroplasty widens the pyloric channel to improve gastric emptying, allowing food to move more efficiently from the stomach into the small intestine. Often combined with vagotomy, this procedure helps restore normal digestive function. Enhanced gastric emptying reduces acid accumulation and supports healing of the ulcerated tissue.