A 25-Year Experience With Vagotomy-Antrectomy

Herrington, J. Lynwood

doi:10.1001/archsurg.1973.01350160087014

Cited by 38 publications

(5 citation statements)

References 15 publications

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“…In our hospital also, SV + A has been performed in 82 patients to date without the experience of recurrence. According to reports from other institutions, as well, the incidence of recurrent ulcer was extremely low, i.e., 0-3.3% (Palumbo et al 1970;Price et al 1970;Herrington et al 1973;Koo et al 1983;Sekine et al 1985). SV + A has thus proved to be an excellent curative means for peptic ulcer.…”

Section: Discussionmentioning

confidence: 96%

“…This problem was said to occur most likely in the cases of (1) severe ptosis of the stomach prior to surgery (Hirota 1970), (2) large sized residual stomach (Kraft and DeWeese 1964), and (3) severe pyloric stenosis (Moore et al 1947). The incidence of this complication was 3.1% (Cerise and Busuttil 1971), 4% (Herrington et al 1973) and 17.4% (Watanabe 1986). While., Jordan (1976) observed that the increased degree of barium retension noted by roentgenogram was unexpected.…”

Section: Discussionmentioning

confidence: 99%

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New additional opration for the prevention of the gastric stasis after selective gastric vagotomy with antrectomy.

Shiratori

Kanaizumi

Murata

et al. 1987

Tohoku J. Exp. Med.

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Selective gastric vagotomy with antrectomy (SV+A) has been performed widely for hyperacidic duodenal ulcer and gastroduodenal ulcer. Compared with extensive distal gastrectomy, SV + A results in excellent reduction of acid out-put, enough to prevent recurrence, and moreover, a lower frequency of some kinds of postgastrectomy syndrome.However, in view of gastric motility, there is the problem of how to prevent

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

New additional opration for the prevention of the gastric stasis after selective gastric vagotomy with antrectomy.

Shiratori

Kanaizumi

Murata

et al. 1987

Tohoku J. Exp. Med.

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“…By 1964 Edwards reported 150 cases without a recurrence or marginal ulcer [6]. By 1973 Herrington and coworkers had 1750 cases with a recurrence rate of 0.7% and 94% rated excellent or good [19]. A large cooperative prospective randomized study at the Veterans Administration hospitals showed the best results with vagotomy and antrectomy [14], and it was the most frequently performed operation for duodenal ulcer during the 1970s and 1980s.…”

Section: Vagotomymentioning

confidence: 99%

From Billroth to PCV: A Century of Gastric Surgery

Weil

Buchberger²

1999

World j. surg.

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The development of gastric surgery is one of the most fascinating chapters in surgical history. The first operations on the stomach were done during the second half of the nineteenth century; at first they were minor procedures but then gradually became more daring, major procedures-albeit with considerable mortality. The work of Theodor Billroth and his pupils ushered in the era of major resectional therapy, first for cancer and later also for ulcer disease. Complications due to the lack of understanding gastric physiology plagued the early days of ulcer surgery, and a variety of modifications tried to remedy these problems. Although the role of the vagus was known through Pavlov's studies, its practical application had to wait until well into the twentieth century. For several decades, resection and vagotomy, separately or combined, were practiced until more sophisticated types of vagotomy began to dominate and replace resection in the surgical treatment of ulcer disease. Resection remained the treatment for cancer. We thus see over a period of 100 years, owing to the increased understanding of physiologic factors, a gradual shift from major resections toward smaller, better directed procedures. The pioneering work of Billroth and his generation, however, must not be forgotten.

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“…Over the years, bilateral TV-A and B-I reconstruction has been our procedure of choice for the elective treatment of DU and its complications [6]. We have used the procedure extensively in cases of gastric outlet obstruction, in many patients with massive bleeding, and among selected patients with an acute ulcer perforation.…”

Section: Bilateral Truncal Vagotomy-antrectomy (Tv-a) Billroth I (B-i...mentioning

confidence: 99%

Bleeding gastroduodenal ulcers: Choice of operations

Herrington

Davidson

1987

World j. surg.

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Management of upper gastrointestinal tract hemorrhage continues to present a challenge in surgical judgment. Endoscopy is the mainstay to precise diagnosis and, although some authorities feel that this modality has not reduced overall mortality, it has, however, played an important role in overall patient management. A bleeding patient may be classified into 1 of 3 separate categories and the algorithms outlined in this article are useful in selecting patients for nonoperative and operative treatment. For the good-risk patient with a massively bleeding duodenal ulcer (DU) who is hemodynamically stable, truncal vagotomy-antrectomy, Billroth I reconstruction is our procedure of choice if the inflammatory process in the duodenum is conducive to a safe resection. Our operative method is described along with variations in technique which are used when conventional end-to-end gastroduodenostomy is not feasible. Closure of the duodenal stump and Roux-en-Y reconstruction or placement of a Roux limb on a severely diseased duodenum following resection is employed in highly selected cases. The Biilroth I1 type of reconstruction is rarely used today in our experience. Truncal vagotomy and pyloroplasty (TV-P) is reserved for the high-risk patient who is bleeding massively. An increasing number of these patients are currently encountered as transfers from our intensive care units with associated multiple organ disease and organ failures. Proximal gastric vagotomy with ulcer undersewing has limited application, in our judgment, when faced with the massively bleeding patient. Gastric resection with or without vagotomy along with ulcer excision is our choice for the massively bleeding gastric ulcer (GU) located in the distal 50-60 % area of the stomach. For the high-risk patient with GU, ulcer excision followed by TV-P is indicated. For the rarely encountered giant GU, gastric resection may be the only option even though the patient is high risk.The choice of the proper operative procedure for the individual patient with massive gastric or duodenal hemorrhage should rest on the experience and the judgment of the surgeon.Upper gastrointestinal tract hemorrhage continues to present a challenging problem in patient management. During the past 2 decades, with the widespread use of fiberoptic endoscopy, the diagnostic accuracy in defining the exact site of bleeding from the gastric and duodenal mucosa is currently in excess of 95%. This modality has virtually rendered radiographic examination in this clinical setting all but obsolete. Although angiography and isotope labeling have been of immense value in the diagnosis of small intestinal and colonic hemorrhage, these studies are infrequently used for the patient suspected of bleeding from the stomach or duodenum.

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A 25-Year Experience With Vagotomy-Antrectomy

Cited by 38 publications

References 15 publications

New additional opration for the prevention of the gastric stasis after selective gastric vagotomy with antrectomy.

New additional opration for the prevention of the gastric stasis after selective gastric vagotomy with antrectomy.

From Billroth to PCV: A Century of Gastric Surgery

Bleeding gastroduodenal ulcers: Choice of operations

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