Ergebnisse der thorakalen Vagotomie bei Billroth I-Anastomosenulcus

Abstract

Thoracic vagotomy is rarely considered today. This procedure is justified only in stomal ulcerations following partial gastrectomy. Since 1974, we have been using this operative method at the Chirurgische Universitätsklinik in Tübingen, Germany, routinely for all cases of stomal ulcerations following Billroth I gastric resection. In contrast to this in stomal ulcerations following Billroth II gastric resection, we perform a converting resection into Billroth I as the standard operation, since in this case control of the duodenal stump for retained antrum is mandatory. To date we have performed thoracic vagotomy in 24 patients. This approach compares well with the abdominal approach. There is a short operating time (average 70 min), a short hospital stay (average 15 days), a low complication rate, and nonexistent mortality. All ulcers, even giant ones penetrating into the pancreas, healed within 6 weeks postoperatively. None of the patients developed postvagotomy diarrhea. On follow-up examination 1.5--6.5 (mean = 4) years after surgery only three patients had a recurrent ulcer. All patients were examined pre- and postoperatively by roentgenography, endoscopy, gastric acid analysis, and serum gastrin evaluation. The Zollinger-Ellison syndrome was excluded in all cases. Because of our excellent results, we consider thoracic vagotomy a safe and successful operative method, which can be recommended as a routine procedure for stomal ulceration following Billroth I gastric resection.