43501 Gastrotomy; with suture repair of bleeding ulcer

Name of the Procedure:

Gastrotomy with Suture Repair of Bleeding Ulcer

Summary

A gastrotomy is a surgical procedure where an incision is made in the stomach to access its inner contents. This technique is used to locate, manage, and repair bleeding ulcers by suturing the affected area to prevent further bleeding.

Purpose

• Medical Condition or Problem Addressed: Bleeding gastric ulcers, which are open sores in the stomach lining that bleed.
• Goals/Expected Outcomes: To stop the bleeding, promote healing of the ulcer, and prevent recurrence or complications such as perforation or severe hemorrhage.

Indications

• Persistent or severe stomach pain.
• Evidence of internal bleeding, such as blood in vomit or stool.
• Ulcers unresponsive to medication.
• Significant anemia due to blood loss from the ulcer.
• Endoscopic findings of a bleeding ulcer that cannot be managed nonsurgically.

Preparation

• Pre-procedure Instructions: Fasting for at least 8 hours before the procedure.
• Medication Adjustments: Patients may need to stop taking anticoagulants or other medications that affect blood clotting.
• Diagnostic Tests/Assessments: Blood tests, endoscopy, and imaging studies like a CT scan to locate the ulcer and assess the extent of the bleeding.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free.
2. Incision: A surgical incision is made in the abdominal wall to access the stomach.
3. Visualization: The stomach is carefully inspected to locate the bleeding ulcer.
4. Suture Repair: The bleeding ulcer is sutured to control hemorrhage. Hemostatic agents may also be used.
5. Closure: The incision in the stomach and abdominal wall is stitched closed.

Tools and Equipment Used:

• Scalpel, surgical scissors, and forceps.
• Sutures and needle holders.
• Hemostatic agents and cautery devices.

Duration

The procedure typically takes between 1 to 2 hours, depending on the complexity and severity of the ulcer.

Setting

The procedure is performed in a hospital operating room under general anesthesia.

Personnel

• Surgeon
• Surgical assistants
• Anesthesiologist
• Operating room nurses
• Scrub technicians

Risks and Complications

• Common Risks: Infection, bleeding, adverse reactions to anesthesia.
• Rare Risks: Perforation of the stomach, leakage from the suture site, abscess formation.

Benefits

• Immediate Benefits: Stopping the bleeding, preventing further blood loss.
• Long-Term Benefits: Improved ulcer healing, reduced risk of recurrence and associated complications.

Recovery

• Post-procedure Care: Hospitalization for monitoring, nasogastric tube if required, intravenous fluids and medications.
• Recovery Time: Generally, 1 to 2 weeks for initial recovery, with complete healing taking several weeks.
• Restrictions: Patients may need to avoid strenuous activities, follow a specific diet, and take medications to reduce stomach acid.
• Follow-up: Regular check-ups with the healthcare provider to monitor healing and prevent recurrence.

Alternatives

• Non-surgical options: Medication to reduce stomach acid, endoscopic treatment.
• Pros and Cons: Non-surgical methods are less invasive but may not be effective for severe bleeding. Endoscopic treatments are minimally invasive but might not be suitable if there is extensive damage or severe bleeding.

Patient Experience

• During the Procedure: The patient will be under general anesthesia and will not feel anything.
• After the Procedure: May experience some discomfort and pain at the incision site, managed with pain medication.
• Comfort Measures: Pain management strategies, such as medications and positioning, to enhance comfort during recovery.