BILLROTH SURGICALPROCEDURE PRESENTATION.pptx

Presentation on billroth

1. OBAFEMI AWOLOWO UNIVERSITY TEACHING HOSPITALS COMPLEX SCHOOL OF PERIOPERATIVE NURSING COURSE-GENERAL SURGERY LECTURER- MR. OGUNWUSI DATE- 5 TH -JULY-2024

2. GROUP 2 MEMBERS OMOLADE KAYODE PON/33/00919 IGE BIBITAYO PON/33/00909 AINA OLUWADETAN PON/33/00901 TOPIC:BILLROTH SURGERY

3. INTRODUCTION BRIEF HISTORY Billroth surgery also known as billroth’s operation, is a surgical operation developed by Theodor Billroth , an Austrian surgeon, in 1881. DEFINITION OF BILLROTH SURGERY It can be defined as the partial removal of the stomach and reconnecting the remaining portion to the small intestine. The procedure is considered a milestone in the development of modern abdominal surgery.

4. ANATOMY OF THE PARTS INVOLVED THE STOMACH DESCRIPTION: The stomach is a J-shaped dilated portion of the alimentary tract situated in the epigastric , umbilical and left hypochondriac regions of the abdominal cavity. PARTS OF THE STOMACH CARDIA The cardia is the top part of your stomach. It contains the cardiac sphincter, which prevents food from traveling back up your esophagus. FUNDUS The fundus is a rounded section next to the cardia . It's below your diaphragm (the dome-shaped muscle that helps you breathe).

5. ANATOMY OF THE PARTS INVOLVED BODY The body (corpus) is the largest section of your stomach. In the body, your stomach contracts and begins to mix food. PYLORUS The pylorus is the bottom part of your stomach. It includes the pyloric sphincter. This ring of tissue controls when and how your stomach contents move to your small intestine. BLOOD SUPPLY Arterial blood is supplied to the stomach by branches of the coeliac artery and venous drainage is into the portal vein. NERVE SUPPLY The sympathetic supply to the stomach is mainly from the coeliac plexus and the parasympathetic supply is from vagus nerves. Sympathetic stimulation reduces the motility of the stomach and the secretion of gastric juice;

6. DIAGRAM OF THE STOMACH

7. ANATOMY OF THE PARTS INVOLVED THE SMALL INTESTINE DESCRIPTION The small intestine is continuous with the stomach at the pyloric sphincter and leads into the large intestine at the ileocaecal valve. It is a little over 5 metres long and lies in the abdominal cavity surrounded by the large intestine. In the small intestine the chemical digestion of food is completed and most of the absorption of nutrients takes place. PARTS OF THE SMALL INTESTINE DUODENUM The duodenum is about 25 cm long and curves around the head of the pancreas. Secretions from the gall bladder and pancreas are released into the duodenum through a common structure, the hepatopancreatic ampulla , and the opening into the duodenum is guarded by the hepatopancreatic sphincter (of Oddi )

8. ANATOMY OF THE PARTS INVOLVED JEJUNUM The jejunum is the middle section of the small intestine and is about 2 metres long ILEUM The ileum, or terminal section, is about 3 metres long and ends at the ileocaecal valve, which controls the flow of material from the ileum to the caecum , the first part of the large intestine, and prevents regurgitation. BLOOD SUPPLY The superior mesenteric artery supplies the whole of the small intestine, and venous drainage is by the superior mesenteric vein which joins other veins to form the portal vein NERVE SUPPLY Innervation of the small intestine is both sympathetic and parasympathetic

9. DIAGRAM OF THE SMALL INTESTINE

10. Partial Gastrectomy Partial gastrectomy refers to resection of the distal stomach for treatment of malignant gastric tumors and complications of peptic ulcer disease such as bleeding, perforation, and obstruction. The extent of gastric resection depends on the type and location of the gastric lesion. The Billroth I procedure is a distal gastrectomy with GI reconstruction to connect the gastric remnant to the duodenum via an end-to-side or end-to-end anastomosis ( gastroduodenostomy ). Billroth I procedures entail resections at, or distal to, the antrum of the stomach.

11. PROCEDURAL CONSIDERATIONS Setup requires basic laparotomy instruments, long instruments, and GI instruments. The patient is supine and general anesthesia induced. The anesthesia provider inserts an NG tube after endotracheal intubation. Insertion of an indwelling urinary catheter occurs before abdominal skin prep. Team members take appropriate precautions to prevent DVT, hypothermia, and pressure injuries.

12. BILLROTH PROCEDURE The surgeon opens and explores the abdomen through an epigastric midline incision. Mobilization of the greater curve of the stomach begins with sharp entry into the gastrocolic ligament, midway along the greater curve. The surgeon mobilizes the first and second portions of the duodenum to facilitate the gastroduodenostomy . The surgeon next mobilizes the lesser curve of the stomach and divides and ligates the right gastric vessels between clamps, preserving the left gastric artery if possible. Anastomosis of the posterior and anterior mucosal layers of the enterotomies is with two 3-0 running absorbable sutures placed through the full thickness of the duodenum and stomach walls.

13. SPECIFIC NURSING INTERVENTIONS Manage pain and discomfort. Monitor for signs of dehydration or electrolyte imbalance Manage nasogastric tubes if present Provide emotional support and counselling Provide wound care Monitor for complications

14. COMPLICATIONS Infection Adhesions Bleeding Hernia Malabsorption Narrowing of the stomach outlet Bowel obstruction

15. BILLROTH II BILLROTH II also know as Billroth's operation II is an operation in which a partial gastrectomy is performed and the cut end of the stomach is closed. The greater curvature of the stomach is connected to the first part of the jejunum in end- to -side anastomosis following the resection of the lower part of the stomach ( antrum ).

16. BILLROTH II The surgical procedure is called " partial gastrectomy and gastrojejunostomy " Billroth II operation is constructed by sewing a loop of jejunum to the gastric remnant ( gastrojejunostomy ). Lastly, a Roux-en-Y gastrojejunostomy involves the creation of a “Roux” limb that is brought and connected to the stomach as well as proximal jejunum.

17. DIAGRAM OF BILLROTH II

18. INDICATIONS FOR BILLROTH II Refractory peptic ulcer disease Gastric adenocarcinoma Billroth II gastrojejunostomy is a procedure that has been performed for tumor or severe ulcer disease in the distal stomach.

19. Surgical steps for Billroth II Setup requires basic laparotomy instruments, long instruments, and GI instruments. The patient is supine position. G eneral anesthesia induced. The anesthesia provider NG tube is inserted after endotracheal intubation. Insertion of an indwelling urinary catheter is done occurs A bdominal skin prep Team members take appropriate precautions to prevent DVT, hypothermia, and pressure injuries

20. Surgical steps cont'd. 1.The surgeon opens and explores the abdomen through an epigastric midline incision. 2. A self-retaining retractor is positioned to optimize exposure. 3 . Mobilization of the greater curve begins with sharp entry into the gastrocolic ligament, midway along the greater curve. 4. The surgeon mobilizes the lesser curve of the stomach and divides the right gastric vessels between clamps. The vessels are ligated . The left gastric artery is preserved if possible. 5. The surgeon fires a large GI stapler across the stomach and directs removal of the Gastric specimen. 6. The surgeon mobilizes a loop of proximal jejunum, pulls it up in front of the colon, and positions it adjacent to the posterior wall of the remaining stomach. 7. The surgeon anastomoses the posterior and anterior mucosal layers of the enterotomies with two 3-0 running absorbable. 8. Closure of the front wall of the anastomosis is with a row of interrupted 3-0 nonabsorbable sutures placed in the seromuscular layer. The anastomosis is complete.

21. COMPLICATIONS Dumping syndrome Gastrojejunocolic fistula Afferent loop syndrome Increased risk of gastric adenocarcinoma,15-20 years post surgery.

22. REFERENCES Hur C, et al. Trends in esophageal adenocarcinoma incidence and mortality. Cancer. 2013;119(6):1149–1158. Hwang JH, et al. Endoscopic mucosal resection. Gastrointest Endosc . 2015;82(2):215–226. King J, Hines O. Anatomy and physiology of the stomach. Yeo CJ. Shackelford's surgery of the alimentary tract. ed 7. Saunders: Philadelphia; 2013. Kwaan MR, et al. Abdominoperineal resection, pelvic Exenteration and additional organ resection increase the risk of surgical site infection after elective colorectal surgery: an American College of Surgeons national surgical quality improvement program analysis. Surg Infect ( Larchmt ). 2015;16(6):675–683.