Expert: John Pilcher, MD - 8/10/2007

Question
Hi John,
My mom is going in for surgery soon, and I was wondering if you could tell me a bit about it. She isn't obese, by any means, but she's had stomach ulcers for a long time, with no response to any kind of treatment. Her doctor says she doesn't NEED this surgery, but it will drastically slash her chances of stomach cancer in the future. The surgery is called "antrectomy Roux-en-y anastomosis". I've tried looking it up, but the only things I can find are in medical journals, and after looking up too many words to count, I'm more lost than when I started! Any info (in somewhat digestible jargon) would be really great. Thanks in advance!
Jes

Answer
Jes,
The operation proposed for your Mom is actually the origin of the Roux-en-Y gastric bypass used for weight loss today.  Ulcer disease has been around for a long time, and it used to be more severe and more widespread than it is currently.  Also, there were not any good medications for blocking stomach acid until the mid 1980's.

Thus, the type of surgery proposed for your Mom was very commonly done in the 1960's and 1970's.  You can't find much about it on the internet today because most cases of ulcer disease can be handled by the meds currently available.  Nevertheless, in cases like you mother, where the situation is refractory (resistant) to treatment with meds, the Vagotomy and Antrectomy with Roux-en-Y anastomosis is a very reasonable step.

These days, when such an operation is done, it is often done by a bariatric surgeon since we are the ones who operate in that general area and do the necessary surgical maneuvers on a routine basis.  One key difference from the gastric bypass done for weight loss is that the surgeon usually leaves a much larger stomach pouch, to keep a somewhat normal food capacity.  Otherwise, you can probably learn correctly about her surgery by reading about the gastric bypass procedure done for weight loss.

One last point - when a patient has persisting ulcers in the face of maximum non-surgical therapy, they should be evaluated for a somewhat rare condition called "gastrinoma."  In this condition, a growth in the pancreas secretes too much gastrin, which is a hormone that stimulates acid secretion by the stomach.

My best wishes to your Mom,
Dr JP