Gastric surgery may be performed on patients with peptic ulcers who have life-threatening hemorrhage, obstruction, perforation, or penetration or whose condition does not respond to medica-tion. It also may be indicated for patients with gastric cancer or trauma. Surgical procedures include a vagotomy and pyloroplasty (disconnecting nerves that stimulate acid secretion and opening the pylorus), a partial gastrectomy, and a total gastrectomy (removal of the stomach) with either an end-to-end or an end-to-side esophagojejunal anastomosis (see Table 37-3).
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