Partial Gastrectomy for Peptic Ulcer

Abstract

An attempt is here made to assess the merits of four types of anastomosis used in partial gastrectomy. The operations were performed for chronic gastric and duodenal ulcer during the six years ending Dec. 31, 1946. We have excluded all cases of carcinoma, those cases of peptic ulcer in which a previous operation other than suture of a perforation had been performed, emergency gastrectomies for haemorrhage, and a few operations in which the pylorus was not removed but was excluded. The series consists of 248 patients, and in reviewing the results we have paid particular attention to (a) the immediate post-operative course, with special reference to complicationsy due to the type of anastomosis, and (b) the functional results. These have been divided into good, fair, and poor. The result is good if the patient is satisfied with the operation and admits to no significant sideeffects. It is fair if the patient is satisfied with the operation but is found to have modified his diet or eating habits to avoid unpleasant symptoms. It is classified as poor when the patient is dissatisfied with the operation or when we have considered the functional result to be unsatisfactory.The length of time since the operation ranges from one to six years, the average period being thirty-seven months. Fifteen patients have not been traced. The last known residence of eleven of these has been visited, but they had left the district and all attempts at follow-up have failed. Visits were not paid to the residences of the other four, as two were known to have left the country and two lived a long distance away.

Retro-anastomotic hernia eight cases of internal hernia following gastrojejunal anastomosis with a review of the literature

“…Incidence.-The incidence of retro-anastomotic herniation has been difficult to assess, because few reports mentioned the number of operations performed. Afferent loop herniation after antecolic partial gastrectomy was reported as occurring i n z of 98 operations by Hsii, Hu, and Hsii (1956), i n 3 of 130 by Mimpriss and Birt (1948), and in 2 of 220 in our series. When the type of anastomosis was not These figures have failed to take account of many large series of operations where this complication has not occurred.…”

Post-gastrectomy Syndromes

“…Symptoms of splanchnic stimulation may be present, and are relieved by vomiting. It is caused by the passage of food into the afferent jejunal loop, and is commonest with left-to-right gastro-jejunal anastomosis (Ogilvie, MY SYNDROMES BRITISH 551 MEDICAL JOURNAL 1947;Mimpriss and Birt, 1948) (Fig. 3, Ic).…”

Partial Gastrectomy: Ten Years Later

“…The operative mortality rate in good hands has been established at 1-2%. The post-gastrectomy syndromes have been studied in detail by Adlersberg and Hammerschlag (1947), Irvine (1948), Mimpriss andBirt (1948), Muir (1949), Wells and Welbourn (1951), and many others. Very little is known, however, about the late results of the operation and the prospects for the patient ten or more years after surgery.…”