Antrectomy for recurrent ulcer after parietal cell vagotomy

Abstract

The results of antrectomy for recurrent ulcer after parietal cell vagotomy are reviewed. Eighteen patients underwent precise antrectomy between 6 months and 7 years after their primary operation. Fourteen patients were reconstructed with a gastroduodenostomy and 4 with a gastrojejunostomy. Eighteen patients were available for follow-up of between 18 months and 10 years. One patient (6.25 per cent) developed a recurrent ulcer 1 year after antrectomy. There was no operative mortality. Six patients (33 per cent) had minor complications in the immediate postoperative period, and one (5.5 per cent) had a major complication. According to Visick grading, 75 per cent had good or excellent results and 25 per cent poor results. Antrectomy following parietal cell vagotomy can be achieved with a low operative mortality, a low ulcer recurrence rate and a satisfactorily low incidence of post-gastrectomy problems.

Roux-en-Y Procedure for Recurrent Ulcer, Bile Reflux and Dumping Syndrome following Antiulcer Gastric Surgery

“…For this reason, acid tests before the antrectomy had not been considered necessary. Antrec tomy alone is an efficient operation for recurrent ulcer ation even after a highly selective vagotomy [4,17], In addition, the reucrrence rate of 6% after antrectomy alone might not be significantly higher from that of 2% after antrectomy plus revagotomy according to the re port of Kennedy and Green [21], On the other hand, the higher mortality and morbidity rates observed after re vagotomy and antrectomy have been attributed by Clark and Ward [9] and Stabile and Passato [33] to the addi tion of revagotomy. The Roux-en-Y procedure without vagotomy is a well-known ulcergenic operation, but the addition of vagotomy minimizes that risk [20].…”

“…There are several operations which are suitable for treating each individual complication [12,17,30], However, difficulties arise whenever a combina tion of two or even three motor disturbances coexist in the same patient, whether or not the ulcer has recurred [11], A particular gastric reconstructive procedure might well treat one gastric motor disturbance but, on the other hand, might leave another unaffected, even aggravate it [19,28], Antrectomy with a Roux-en-Y gastrojejunostomy has been reported to be equally effective in almost totally abolishing EGR [36] and in delaying gastric emptying of liquids [28,31], Additionally, Cooper and Bell [10] have used this procedure to treat peptic ulcer recurrence if the original antiulcer operation is a type of vagotomy with or without a drainage procedure. Taking into account these data we applied antrectomy with Roux-en-Y gastrojeju nostomy in a series of patients suffering from a combina tion of either enterogastric reflux and gastric inconti nence or/and recurrent ulceration.…”

Billroth-I-Hemigastrektomie beim komplizierten Ulkusrezidiv nach selektiv proximaler Vagotomie

“…Hoffmann et al [11] sahen bei ihren Patienten nach einem vergleichbaren Follow-up (durchschnittlich 4 Jahre) in 6,3% neuerliche Rezidive [11]. Hoffmann et al [11] sahen bei ihren Patienten nach einem vergleichbaren Follow-up (durchschnittlich 4 Jahre) in 6,3% neuerliche Rezidive [11].…”