Gastric emptying after treatment of stenosis secondary to duodenal ulceration by proximal gastric vagotomy and duodenoplasty or pyloric dilatation.

White, C. M.; Harding, L. K.; Keighley, M. R. B.; Dorricott, N. J.; Alexander-Williams, J

doi:10.1136/gut.19.9.783

Cited by 30 publications

(7 citation statements)

References 10 publications

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“…The surgical management of these patients has progressed from resective gastric procedures that either removed or bypassed the obstructed segment to nonresective acid-reducing procedures combined with some procedure to alleviate the obstruction. Among the latter have been attempts to dilate the area of narrowing, [1][2][3] widen or modify the involved segment by plasty, [4][5][6] and, more recently, to excise the obstructing scarred segment of the duodenum in combination with an acid-reducing operation. 7,8 This article relates our initial experience with both partial duodenectomy (PD) and complete circular duodenectomy (CCD) combined with highly selective vagotomy (HSV) in the treatment of severe obstructing duodenal ulcer disease.…”

Section: Discussionmentioning

confidence: 99%

Partial or Complete Circular Duodenectomy With Highly Selective Vagotomy for Severe Obstructing Duodenal Ulcer Disease

Chang

Chen²,

Shih³

et al. 1998

Arch Surg

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To evaluate partial and complete circular duodenectomy combined with highly selective vagotomy (HSV) for relief of gastric retention.Design: A retrospective, case-comparison study.Setting: University hospital referral center.Patients: Eighteen patients with severe obstructing duodenal ulcer disease defined by failure of a saline load test and endoscopic narrowing of the gastric outlet to 5 mm or less.Methods: In patients with severe obstructing ulcer the diseased duodenal segment was excised with electrocautery (partial excision, 10 patients; complete excision, 8 patients). An HSV was then done. Postoperative fasting gastric residuum measurement and measurement of the emptying of liquids and solids was done at 3 months and patients were weighed at 3 and 12 months.

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Section: Discussionmentioning

confidence: 99%

Partial or Complete Circular Duodenectomy With Highly Selective Vagotomy for Severe Obstructing Duodenal Ulcer Disease

Chang

Chen²,

Shih³

et al. 1998

Arch Surg

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“…Gastric outlet obstruction (GOO) has been reported to occur in 6% to 8% of patients with DUs [63]. The double aim of proposed operations include relieving obstruction while controlling peptic ulcer disease [64,65]. Evaluation of the effectiveness of surgical treatment was based on recurrence and restenosis rates.…”

Section: Gastric Outlet Obstructionmentioning

confidence: 99%

Surgical Treatment of Complicated Duodenal Ulcers: Controlled Trials

Millat¹,

Fingerhut

Borie³

2000

World j. surg.

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Indications for surgery of duodenal ulcer (DU) have changed radically because of the efficacy of H(2)-antagonists, endoscopic procedures, and eradication of Helicobacter pylorus. The aim of this study was to analyze the current literature to determine if definitive surgery is still relevant for complicated DU (bleeding, perforation, gastric outlet obstruction). Two studies have compared early to late surgery in terms of bleeding. One recommended early surgery (significant reduction in mortality) in the elderly, but no statistically significant difference was found when analyzed with "intention to treat." In the other, mortality with early surgery was five times higher than with expectant therapy (when it was possible). Two studies comparing different surgical techniques for bleeding favored the radical procedure. Of at least 15 studies comparing endoscopic treatments, however, none has compared endoscopic therapy to surgical intervention for bleeding DU. One trial, comparing nonoperative to surgical treatment for perforation, found similar rates of morbidity, intraabdominal abscess, and mortality; but the hospital stay was longer (p < 0.001). Nonoperative treatment failed more often (p < 0.05) in patients over age 70. In three trials, postoperative morbidity (excepting wound sepsis in one) was not significantly increased by definitive surgery, with less ulcer recurrence (p < 0.05) compared with simple closure. Laparoscopy (versus laparotomy) was shown to take longer (p < 0.001) but required less postoperative analgesics (p < 0.03); there were no statistically significant differences as concerns the duration of nasogastric aspiration, intravenous drips, hospital stay, time to resume normal diet, Visual Analogous Scale pain scores for the first 24 hours after surgery, morbidity, reoperation rate, or mortality. Of 48 laparoscopic patients, 11 (23%) underwent conversion to open surgery. Three surgical techniques [highly selective vagotomy (HSU) + gastrojejunostomy (group 1), HSV + Jaboulay gastroduodenostomy (group 2), or selective vagotomy (group 3) + antrectomy) for gastric outlet obstruction (GOO)] showed that although postoperative results were similar (except wound sepsis in one trial), long-term Visick scores were significantly (p < 0.01) better in group 1 than in group 2, but not in group 3. Further studies are needed to determine the exact prevalence of Helicobacter pylori in complicated DU and to compare (1) definitive to minimal surgery (stop the bleeding or close the perforation) combined with antisecretory drugs and eradication of H. pylori; (2) surgery to endoscopic treatment combined with eradication of H. pylori; and (3) for GOO, surgery to balloon dilatation combined with eradication of H. pylori.

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“…HSV plus drainage would produce a higher incidence of dumping syndrome due to the loss of an intact pylorus [3]. Nevertheless, HSV combinedCorrespondence to: C.-S. Wang, M.D.with these additional procedures are still recommended as a good operation for obstructing duodenal ulcers [4][5][6][7][8][9][10].The superiority of HSV over other types of peptic ulcer surgery for uncomplicated duodenal ulcers have been confirmed by its advantage in preserving normal gastric emptying [11][12][13]. For obstructing peptic ulcer, gastric emptying is usually a problem before HSV and may be altered postoperatively by additional procedures for relief of the stenosis.…”

mentioning

confidence: 97%

“…HSV plus drainage would produce a higher incidence of dumping syndrome due to the loss of an intact pylorus [3]. Nevertheless, HSV combined with these additional procedures are still recommended as a good operation for obstructing duodenal ulcers [4][5][6][7][8][9][10].…”

mentioning

confidence: 99%

“…The undesirable side effects after peptic ulcer surgery are often accompanied with an abnormal change of gastric emptying [14]. Reports are still few regarding the change of gastric emptying after HSV for obstructing peptic ulcers [4,11]. Our study is focused on the change of gastric emptying and its correlation with clinical results following HSV plus dilatation or drainage in the treatment of obstructing duodenal ulcer.…”

mentioning

confidence: 99%

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Effects of highly selective vagotomy and additional procedures on gastric emptying in patients with obstructing duodenal ulcer

et al. 1994

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A solid gastric emptying study was conducted on 46 patients more than 1 year after highly selective vagotomy (HSV) and additional procedures for obstructing duodenal ulcer and on 21 patients after HSV alone for uncomplicated duodenal ulcer. The additional procedures included dilatation (n = 14; HSV + D group), Holle pyloroplasty (n = 14; HSV + P group), and Jaboulay gastroduodenostomy (n = 18; HSV + GD group). The test meal consisted of two eggs labeled with 99mTc sulfur colloid, two slices of white bread toast, and 300 ml of orange juice (total 322 kcal). Gastric emptying curves and emptying parameters (t1/2, half emptying time; lag phase, TLAG; emptying rate, k; and beta value) were compared with those of 17 healthy volunteers, the normal control group. The patients after HSV alone had an almost normal gastric emptying. The HSV + D group showed a significant delay from minute 45 to the end of the emptying curve, corresponding to a longer t1/2 (p = 0.02), and a slower emptying rate (p = 0.029). The HSV + P group approached a nearly normal emptying curve, corresponding to an insignificant difference in emptying parameters. The HSV + GD group had significantly faster emptying from minute 15 to the end of the emptying curve, corresponding to a faster t1/2 (p = 0.0005), a shorter lag phase (p = 0.027), and a faster emptying rate (p = 0.021). Recurrent ulcerations were noted in one patient (4.8%) of the HSV alone group, five (35.7%) of the HSV + D group, one (7.1%) of the HSV + P group, and one (5.6%) of the HSV + GD group.(ABSTRACT TRUNCATED AT 250 WORDS)

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Gastric emptying after treatment of stenosis secondary to duodenal ulceration by proximal gastric vagotomy and duodenoplasty or pyloric dilatation.

Cited by 30 publications

References 10 publications

Partial or Complete Circular Duodenectomy With Highly Selective Vagotomy for Severe Obstructing Duodenal Ulcer Disease

Partial or Complete Circular Duodenectomy With Highly Selective Vagotomy for Severe Obstructing Duodenal Ulcer Disease

Surgical Treatment of Complicated Duodenal Ulcers: Controlled Trials

Effects of highly selective vagotomy and additional procedures on gastric emptying in patients with obstructing duodenal ulcer

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