Gastrorrhaphy, suture of perforated duodenal or gastric ulcer, wound, or injury
CPT4 code
Name of the Procedure:
Gastrorrhaphy
- Common Names: Stomach Suturing, Duodenal/Gastric Ulcer Repair
- Technical Terms: Suture of Perforated Duodenal Ulcer, Suture of Perforated Gastric Ulcer, Gastrorrhaphy
Summary
Gastrorrhaphy involves sewing together a tear or perforation in the stomach or duodenum to repair it. This is typically done to fix ulcers or injuries that have caused a hole in the stomach or intestinal lining.
Purpose
Medical Condition:
- Perforated duodenal or gastric ulcer
- Gastric or duodenal wounds or injuries
Goals/Expected Outcomes:
- To close the perforation and prevent leakage of stomach contents into the abdominal cavity.
- To reduce pain and prevent severe complications such as peritonitis or sepsis.
- To promote healing of the injured or ulcerated area.
Indications
- Severe abdominal pain with signs of acute abdomen
- Evidence of stomach or duodenal perforation on imaging tests
- Presence of peritonitis (infection of the abdominal cavity)
- Failure of non-surgical treatments for ulcers or injuries
Preparation
Pre-procedure Instructions:
- Fasting for at least 6-8 hours before surgery
- Stopping certain medications as advised by the doctor (e.g., blood thinners)
- Intravenous (IV) fluids and antibiotics might be administered prior to surgery
Diagnostic Tests:
- Blood tests (CBC, electrolytes)
- Imaging studies like X-ray or CT scan of the abdomen
- Endoscopy may be performed to visualize the perforation
Procedure Description
- Anesthesia: General anesthesia is administered.
- Incision: A surgical incision is made in the abdomen to access the stomach or duodenum.
- Identification: The perforation, ulcer, or injury is located.
- Suturing: The tear or hole is carefully closed with sutures.
- Inspection: The area is inspected for any additional injuries, and the abdominal cavity is cleaned if there is any contamination.
- Closure: The abdominal incision is closed with sutures or staples.
Tools/Equipment:
- Surgical sutures and needles
- Surgical instruments like scalpels, forceps, and retractors
- Anesthesia and monitoring equipment
Duration
The procedure typically takes around 1-2 hours, depending on the complexity and condition of the patient.
Setting
Gastrorrhaphy is typically performed in a hospital's operating room under sterile conditions.
Personnel
- Surgeon
- Anesthesiologist
- Surgical nurses
- Operating room assistants
Risks and Complications
Common Risks:
- Infection
- Bleeding
- Postoperative pain
Rare Risks:
- Leakage from the repaired site
- Abscess formation
- Adverse reaction to anesthesia
- Prolonged ileus (intestinal paralysis)
Management:
- Postoperative antibiotics
- Monitoring for signs of complications
- Pain management protocols
Benefits
- Relief from severe abdominal pain
- Prevention of life-threatening complications like peritonitis
- Restoration of normal gastrointestinal function
- Expected benefits are often seen within days to a week post-surgery.
Recovery
Post-procedure Care:
- Hospital stay for monitoring (usually a few days)
- Pain management with medications
- Gradual return to a normal diet as the intestines recover
- Avoiding strenuous activities for several weeks
Expected Recovery Time:
- Full recovery may take 4-6 weeks.
- Follow-up appointments to monitor healing and address any concerns
Alternatives
- Non-surgical treatments: Antibiotics, proton pump inhibitors (PPI) for managing ulcers (typically not effective for perforated ulcers)
- Endoscopy: In some cases, non-surgical endoscopic repair might be considered, but often surgery is the definitive treatment.
Pros and Cons:
- Surgery provides immediate and definitive repair, whereas non-surgical methods might not be effective for perforations and can delay necessary treatment.
Patient Experience
During the Procedure:
- The patient will be under general anesthesia and will not feel anything during the surgery.
After the Procedure:
- Initial discomfort and pain managed with medications
- Gradual improvement in symptoms like pain and abdominal tenderness
- Possible dietary restrictions initially, progressing to regular diet as tolerated
Pain Management and Comfort:
- Pain relief with prescribed medications
- Support from nursing staff for mobility and daily activities during hospital stay