Stomach Ulcer Surgery: Everything You Need to Know

Stomach ulcer surgery (a.k.a. ulcer surgery, gastric ulcer surgery, or peptic ulcer surgery) is a procedure for treating a stomach ulcer. The surgery is used when peptic ulcer disease causes pain or bleeding that doesn't improve with non-surgical therapies. Perforated ulcer surgery is an urgent life-saving intervention for severe ulcer-induced degradation of the stomach lining. Symptoms caused by your ulcer should improve after you recover from the procedure.

What Is Stomach Ulcer Surgery?

Peptic ulcer surgery is an operation for repair of stomach damage that's caused by an ulcer. A stomach ulcer is an erosion on the inside of the stomach lining, and it is also referred to as a peptic ulcer or a gastric ulcer. It can develop slowly, and you may have more than one at a time.

Approaches used in stomach ulcer surgery include:

• Laparotomy: An open procedure with a large abdominal incision
• Minimally invasive laparoscopic surgery: Involves a small abdominal incision and the use of a camera-equipped surgical device for visualization and repair
• Endoscopic procedure: A flexible tube is inserted into the throat and advanced down into the stomach to repair the ulcer with the assistance of a camera and surgical tools

Procedure Types

The one chosen depends mostly on the surgical technique being used. There are a few, and you and your healthcare provider will discuss these options in advance to determine which might be appropriate and best in your case.

Graham Patch

With this technique, a patch of omentum (fatty tissue that normally covers the stomach and intestines) is transferred to cover a hole formed due to a small ulcer. This patch is sutured into place.

This technique can be done with an open laparotomy or laparoscopically.

Partial Gastrectomy

With a partial gastrectomy, a small region of the stomach is cut away as the gastric ulcer is removed. This procedure is used when the ulcer is large and deep.

The hole that's formed in the stomach after the ulcer is resected is then surgically closed; if the ulcer is located near the duodenum (opening of the small intestine), the stomach needs to be re-connected to the small intestine.

This is usually an open laparotomy and may be done laparoscopically.

Vagotomy

A vagotomy is a surgical procedure in which one or more branches of the vagus nerve is cut or removed. This is done to reduce stomach acid, the release of which is stimulated by the vagus nerve and can exacerbate an ulcer.

A vagotomy is rarely performed on its own and is usually part of a procedure that includes another surgical intervention. For example, it may be done with a pyloroplasty—enlargement of the opening between the stomach and the duodenum so the stomach contents can pass more freely.

The surgical method used for vagotomy depends on the other interventions that are being done, but it can be done with an open laparotomy or laparoscopically.

Contraindications

There are several issues that may prevent you from having peptic ulcer surgery.

You may not be able to have this surgery if your stomach ulcer is very large or not repairable with surgery.

Sometimes a chronic illness, like Crohn's disease can make you susceptible to recurrent ulcers, and surgical treatment may not be a definitive therapeutic approach.

Additionally, if you have a severe illness, like cancer, you might not be able to tolerate the surgery; this could be a contraindication to having the procedure.

Potential Risks

These procedures can cause immediate surgical complications or may result in delayed digestive issues. Some immediate complications are due to unplanned surgical events, while delayed problems are generally related to structural changes that are an inherent part of the therapeutic procedure.

Operative complications can include infection, bleeding, a new perforation, or an injury to the esophagus, stomach, or small intestine.

These issues may cause:

• Pain
• Fevers
• Nausea
• Vomiting
• Hematemesis (vomiting blood)
• Blood in the stool
• Dizziness

Excessive postoperative inflammation can cause gastrointestinal obstruction, with pain, abdominal distension (swelling of the abdomen), severe constipation, and vomiting.

Purpose of Stomach Ulcer Surgery

Peptic ulcers can cause pain, stomach discomfort, abdominal cramps, decreased appetite, hematemesis, gastrointestinal bleeding, iron deficiency anemia (a type of red blood cell deficiency), and malnutrition.

Generally, the condition can be effectively treated with medication and lifestyle changes, rather than with surgical intervention. Smoking and alcohol use can contribute to stomach ulcers, and stopping these habits can help an ulcer heal. Sometimes dietary modifications, like avoiding spicy foods, can help control symptoms.

Treatments for gastric ulcers include proton pump inhibitors (PPIs) and antibiotics to eradicate Helicobacter pylori, a bacteria that is commonly associated with stomach ulcers.

Surgical management may be needed for complications of peptic ulcer disease or for treatment of a stomach ulcer that doesn't improve despite conservative management.

Issues that may warrant surgical intervention for the treatment of peptic ulcer disease include:

• Perforation: An ulcer can form a hole in the wall of the stomach. This is a life-threatening complication that results in leaking of digestive juices, food, and bacteria from the stomach into the abdominal cavity. A perforated ulcer causes sudden, severe stomach pain, and it can result in a fever, profuse bleeding, dangerous blood chemistry abnormalities, and loss of consciousness.
• Bleeding: A bleeding ulcer may manifest with blood in the stool (it can appear bright red or black) and/or hematemesis. It can be painful or painless. Typically, a bleeding ulcer is treated with endoscopic repair, and if the bleeding is profuse and sudden, emergency surgery may be needed.
• Gastric outlet obstruction: Gastric outlet obstruction is a rare complication of stomach ulcers that cause swelling or scarring. These issues narrow the stomach so that its contents can't pass through. Symptoms include vomiting and abdominal pain. Gastric outlet obstruction may be relieved with an upper endoscopy or with a surgical procedure, and the ulcer would be treated at the same time.
• Refractory or recurrent disease: Stomach ulcers that don't improve or that worsen despite non-surgical treatment may require surgical intervention. Resistant, non-healing ulcers can be caused by a gastric-fluid producing disease like Zollinger-Ellison syndrome or by the erosion of the stomach lining due to gastric cancer.

These issues can cause persistent and serious health problems. Stomach ulcer surgery would be done to alleviate your symptoms and prevent consequences to your overall health.

How to Prepare

Before your surgery, your practitioner will obtain imaging tests to help plan your procedure. This can include non-invasive tests, as well as imaging obtained with an endoscopy. You will also have blood tests, like a complete blood count (CBC) to evaluate you for anemia.

In preparation for surgery and anesthesia, you will need to have an electrocardiogram (EKG), chest X-ray, and a blood chemistry panel. Medical issues, like anemia or abnormal electrolyte levels (such as altered calcium or potassium), may need to be corrected before you can proceed with your surgery.

Your healthcare provider will also discuss the surgical technique with you and will explain whether you will have a surgical incision and a post-operative scar.

Location

An open laparotomy or laparoscopic procedure would be performed in an operating room in a hospital or surgical center.

An endoscopic surgery would be done in an operating room or a procedural suite, either of which could be in hospital or surgical center.

What to Wear

You should wear something comfortable to your surgery appointment. Make sure you have clothes that don't have a tight waist to wear on your way home.

Additionally, you might have a surgical drain if you are having laparoscopic surgery, so it is best if you wear clothes with easy access to your abdominal area (avoid a dress; consider wearing a loose shirt or one with buttons).

Food and Drink

You will need to fast from eating and drinking after midnight the night before your surgery.

Medications

Your healthcare provider may adjust some of your medications in the days or weeks before your peptic ulcer surgery. For instance, you might be directed to change the dose or stop blood thinners that you are taking. And you may also need to adjust the dose of anti-inflammatory medications, diabetes medications, or treatments that you take for your peptic ulcer disease.

What to Bring

When you go to your surgery appointment, you should take a form of personal identification, your insurance information, and a method of payment if you are responsible for paying for some or all of the cost of your surgery.

You should also have someone with you who can take you home because you will not be able to drive for at least a few days after your surgery.

Pre-Op Lifestyle Changes

Before your surgery, your healthcare provider will advise you to avoid smoking and drinking alcohol so that your ulcer is not further irritated. You might also be instructed to avoid eating things that can exacerbate a peptic ulcer, such as spicy or acidic foods.

What to Expect on the Day of Surgery

When you go to your surgery appointment, you will register and sign a consent form. You may have some pre-operative testing before you go to the pre-surgical area. These tests may include a chest X-ray, CBC, blood chemistry panel, and a urine test.

You will be asked to change into a hospital gown. You will have your temperature, blood pressure, pulse, respiratory rate, and oxygen level checked.

If you are having stomach ulcer surgery for an emergency, like a perforation, your preparation will happen quickly. You will need to have IV fluids and possibly a blood transfusion during this period.

Before the Surgery

Before your procedure is started, you will have specific preparation and anesthesia that corresponds to the type of procedure you are having.

• IV sedation: This is used for an endoscopic procedure. For this type of sedation, you will have the anesthetic medication injected into your IV to make you sleepy. Your pulse, blood pressure, respiratory rate, and oxygen level will be monitored from start to finish. You might fall asleep before or during your surgery. Additionally, if you will have an endoscope placed in your mouth, oral anesthetic medication (in your mouth and throat, usually via a spray) will be used to ease any discomfort.
• General anesthesia: This is used if you are having an open laparotomy or a minimally invasive laparoscopic procedure. General anesthesia involves the injection of IV anesthetic medication that would put you to sleep, decrease your sensation, and prevent you from moving. For this type of anesthesia, you would have a tube placed in your throat so you can breathe with mechanical assistance during your surgery.

If you are having an open laparotomy or a minimally invasive laparoscopic surgery, a drape will be placed over your body. A small area of your skin will be exposed where the incision will be placed. Your skin will be cleansed before the surgery starts.

These steps are not necessary before endoscopic stomach ulcer surgery.

During the Surgery

Your surgical procedure will begin after the preparation steps. The next steps will depend on which technique your surgeon is using to treat your peptic ulcer.

Endoscopic Surgery: Step by Step

If you are having an endoscopic surgery, once you are asleep, the endoscope is gently advanced through your mouth and esophagus into your stomach. You shouldn't feel any discomfort during this process.

Your healthcare provider will be able to see your ulcer and the surrounding structures on a monitor with the aid of the endoscopic camera. Surgical tools that are inserted through the endoscopic device will be used to treat and control ulcer bleeding.

Various tools, including clips, electric cautery, and injectable agents, are used to stop bleeding and prevent recurrent bleeding.

When the treatment is complete, the endoscope is removed.

Laparoscopic Surgery: Step by Step

For a laparoscopic procedure, your surgeon will make a small skin incision that is approximately two inches in length. Then they will cut through the peritoneum (membrane lining the abdomen) and fat that encloses your stomach and intestines. Your surgeon will cut a small opening in your stomach as well.

The laparoscopic device, which is equipped with surgical tools and a camera, is inserted through the opening of the skin, advanced into the peritoneum and then the stomach where it's used to visualize the structures on a monitor.

Your surgeon will proceed with your surgery, which may include cutting a portion of your vagus nerve, cutting away the ulcer and repairing the abdomen, or patching the ulcer with healthy tissue. This process will involve the placement of sutures and control of bleeding.

After the stomach ulcer is surgically treated, your surgeon will close the peritoneum and the skin. You might have a surgical drain placed in your peritoneum or stomach and extended outside your body to collect blood and fluid as you are healing.

Open Laparotomy: Step by Step

For an open peptic ulcer surgery, your surgeon will make an incision that measures three to six inches. They will also cut through your peritoneum and into your stomach, near your peptic ulcer.

Your surgery may include resection of your ulcer and attaching your stomach opening to the opening of your small intestine, surgically closing a newly created opening in your stomach, or suturing healthy tissue to patch your ulcer.

After the repair, you may have a drain placed, and your peritoneum and skin will be closed with sutures.

Once your surgery is complete, your surgical wound will be covered with a dressing. Your anesthesia medication will be stopped, and your breathing tube will be removed. When you are medically stable and breathing well on your own, you will go to a postoperative recovery area.

After the Surgery

In the recovery area, your medical team will monitor your health, including your pain or discomfort, fluid in your drain, and whether you are passing gas. You will be assessed for signs of complications, such as hematemesis, vomiting, and severe abdominal pain.

After a few hours, you will be asked to drink clear fluids. Your medical team will ask you to slowly advance your food and drink liquids. You will need to be able to eat solid food, like a cracker without experiencing any pain or vomiting before going home.

• Barring any complications, you are likely to go home on the day of your procedure if you are having your peptic ulcer surgery endoscopically.
• An open laparotomy or laparoscopic surgery usually involves an overnight stay of one or two days.

If you develop problems (like severe pain or vomiting) as your diet is advanced, you may need further evaluation.

Before discharge, your medical team will discuss advancing your diet, pain control, and how to care for your drain and wound (if applicable). You will be given guidance regarding when to schedule follow-up appointments with your healthcare provider, as well.

Recovery

After surgery for a stomach ulcer, it will take time to fully heal. You will need to gradually advance your diet, and the pace at which to do so depends on the type of surgery you had and your tolerance for food.

For example, your healthcare provider might advise that you drink clear fluids for a given amount of time, and then advance to bland soft food when it's clear that you are tolerating the earlier step.

As a general rule of thumb, your recovery will be faster and easier after an endoscopy, and more gradual if you have had a laparoscopy, with a longer recovery if you've had an open laparotomy. The need for a drain usually corresponds with a slower recovery as well.

Any immediate postoperative complications, such as an infection or extensive swelling, can prolong full recovery.

Healing

If you have a wound and drain, you will need to make sure that you take care of them as instructed while you heal. That means keeping them dry and clean when you are bathing.

You will receive a prescription for pain medication, which should be used as directed. You might also receive a prescription medication and dietary instructions to control constipation.

Coping With Recovery

As you are recovering after surgery, you may be somewhat sore, especially if your surgery was not an endoscopic procedure. It is best not to push yourself when it comes to physical activity.

You can get up and walk, but don't run or lift heavy objects until your wound is fully healed and your drain is removed.

Long-Term Care

You may need to take antacid medication if you have problems with stomach upset or heartburn. Sometimes taking medication can prevent another ulcer from developing, and your healthcare provider will advise you about this based on your risk of developing another ulcer.

Possible Future Surgeries

Generally, a stomach ulcer surgery shouldn't lead to future procedures. If you develop issues like postoperative obstruction or perforation, you could need to have another surgery to treat these problems.

Lifestyle Adjustments

After stomach ulcer surgery, you might benefit by adjusting your diet and habits for the long term. This may include continued avoidance of smoking and alcohol, as well as acidic and spicy foods.

If you have a problem with gastric motility, your healthcare provider may advise that you eat small, frequent meals rather than large meals to avoid bloating or nausea.

A Word From Verywell

Surgical management of peptic ulcer disease is not the most common therapeutic approach for treating the condition. It's used for treating a perforated ulcer or complicated peptic ulcer disease. You may need to make some dietary and lifestyle adjustments in advance of and after surgery to maximize the benefits.