Surgery of the stomach can be a challenge in the rural setting due to the potential lack of necessary infrastructure for the management and diagnosis of the peri- and postoperative complications. Treatment of benign and malignant conditions of the stomach in the emergency and elective setting still remains an important part of rural general surgery. As opposed to other gastrointestinal malignancies, the incidence of gastric cancer has been significantly decreasing during recent years. Upper gastrointestinal hemorrhage is the domain of endoscopic intervention, uncontrollable blood loss however requires more invasive surgical intervention and definitive treatment. Blood loss of more than 2 liters, failed endoscopic treatment and need for more than 1 liter of blood during 24 hrs should prompt surgical intervention in these patients. Gastric/duodenal perforations can be treated with minimal invasive surgery and require additional high dose proton pump inhibitor therapy. Reconstruction after gastrectomy is usually done by a Roux-en-Y esophago-jejunostomy with entero-entero-anastomosis of the Roux-en-Y limb 40-60 cm distal to the esophago-jejunostomy.
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