Q) Which of the following is true about giant gastric ulcer?
a) 70-80% of these ulcers are malignant
b) By definition giant gastric ulcer is more than 1.5 cm in size
c) Medical therapy can heal 80% of such ulcers
d) They are more common on the greater curvature and invade surrounding organs like spleen, liver etc
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Q) What is true regarding complications of billroth 2 surgery?
a) It has less complications than billroth 1 surgery
b) Recurrent ulceration is more common in the afferent limb as compared to efferent limb.
c) Afferent loop obstruction is more common after billroth 2 surgery
d) Billroth I operation is preferred in scarred duodenum
Answer c -
In billroth 2 surgery, afferent limb obstruction is more common
In surgery for benign gastric ulcers, billroth I reconstruction is the preferred choice. Billroth II surgery has problems of
- Retained antrum syndrome
- Afferent loop obstruction
- Duodenal stump leak (1-3%)
Billroth 2 surgery is done when there is
1. Inadequate mobility of the duodenum
2. Scarring of duodenum
Complications of gastric surgery
Complications of gastrectomy
- Nutritional and weight loss - Iron deficiency, Copper deficiency, Vit B12 , Anemia
- Delayed gastric emptying
- Roux statsis- Seen in roux en y loops- Pain, nausea, vomiting, abdominal bloating
- Cholelithiasis- Higher incidence in roux en y reconstruction as compared to B1 and B 2 gastrectomy
- Recurrent ulceration
Complications of Billroth 2 surgery
- Dumping syndrome
- Afferent loop obstruction - It can be minimized by keeping the length of afferent loop less than 20 cm and using a retrocloic approach.
- Bile reflux gastritis - More common with billroth I and billroth 2 surgery, incidence is decreasing after the use roux en y anastomosis