Peritoneoscopy as an aid to diagnosis

Johnston, I. D. A.; Rodgers, H. W.

doi:10.1136/gut.5.5.485

Cited by 6 publications

(2 citation statements)

References 6 publications

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“…Preservation of a normal antrum, pylorus, and duodenum should carry other advantages. For example, this region is the site of the physiological 'brake' on gastric motility (Thomas, 1957) and secretion in man (Griffiths, 1936;Shay, Gershon-Cohen, and Fels, 1942;Gillespie, 1959;Ksster and Rune, 1963;Johnston and Duthie, 1964, 1969. The secretory inhibition probably has both a nervous component (Code and Watkinson, 1955 ;Iggo, 1957;Sircus, 1958;Duthie, 1966, 1969) and a humoral component (Woodward, Lyon, Landor, and Dragstedt, 1954;Greenlee, Longhi, Guerrero, Nelsen, El-Bedri, and Dragstedt, 1957 ;Andersson, 1960Andersson, , 1963Andersson, , 1969Kamionkowski, Grossman, and Fleschler, 1964;Wormsley and Grossman, 1964;Johnston and Duthie, 1966).…”

Section: Discussionmentioning

confidence: 99%

Highly selective vagotomy without a drainage procedure in the treatment of duodenal ulcer

Johnston

Wilkinson

1970

Journal of British Surgery

296

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SUMMARYA consecutive series of 25 patients with chronic duodenal ulcer has been treated by highly selective vagotomy without a drainage procedure. The vagal fibres passing to the distal 5-7 cm. of the stomachthe nerves of Latarjet-were left intact, as were the hepatic and coeliac branches of the vagus. The object was to denervate only the parietal cell mass, while preserving normal gastric emptying and normal inhibition of gastric secretion from the antrum and duodenum. This operation should cure the ulcer as effectively as vagotomy with drainage does, and at lower cost in terms of side-effects such as dumping and diarrhoea.The insulin te,jt was negative in each case, suggesting that vagal denervation of the parietal cell mass was complete. Evidence provided by mucosal biopsies taken at operation does not fully support this view, however. Pentagastrin-stimulated acid output was reduced by 70 per cent, and pepsin output by 51 per cent, 3 months after operation. The volume of resting juice was halved and spontaneous acid output was reduced by 97 per cent at this time. Thus, highly selective vagotomy is as effective as truncal or bilateral selective vagotomy with drainage in reducing gastric acid output in the early months after operation.There have been no deaths. With 2 exceptions, the patients appear to be doing well clinically and few complain of side-effects, but the period of follow-up is only from 3 to 11 months.These results are encouraging. They suggest that a highly selective vagotomy, denervating the parietal cell mass but leaving the antrum innervated, may be all that is required to cure most patients who have a chronic duodenal ulcer.A CONSECUTIVE series of 25 patients with chronic duodenal ulcer has been treated by highly selective vagotomy without any form of drainage procedure. The vagotomy WBS confined to the acid-and pepsinsecreting area, the distal 5-7 cm. of the stomach being left innervated. This operation is thought to possess two specific advantages over truncal or bilateral selective vagotomy with drainage. First, gastric emptying should be almost normal and as a result dumping should be eliminated, because the antropyloroduodenal segment remains normal anatomically and its extrinsic vagal nerve-supply is kept intact. Secondly, the neurohumoral inhibitory mechanisms in the antrum and duodenum, which 'apply the brake' to gastric secretion, are preserved. Thus, postoperatively, inhibition is still lively, whereas maximal acid output is only 30 per cent of its former level. This should be enough to ensure that the ulcer heals and remains healed. Table I) who have been treated during the period February to October, 1969. I n each case the diagnosis of duodenal ulceration was made clinically, radiologically, and at operation. The series is consecutive, except that patients with pyloric stenosis and emergency cases were excluded. I n an attempt to detect patients with early pyloric stenosis, special attention was paid to symptoms such as vomiting, acid regurgitation, or heartburn, and to the natur...

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Section: Discussionmentioning

confidence: 99%

Highly selective vagotomy without a drainage procedure in the treatment of duodenal ulcer

Johnston

Wilkinson

1970

Journal of British Surgery

296

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“…It is his notable submission in light of contemporaries with no problems using AA. [29][30][31][32][33][39][40][41][42] Significantly, Kalk published in 1939, one of the largest series of laparoscopic surgery of 2000 procedures without mortality when others had mortality of 2-5%. 43 Ruddock reported in 1949, "After local anesthetization, the pneumoperitoneum needle is inserted and the abdomen tightly distended with ordinary unfiltered air pumped in with a baumanometer bulb… to keep the cavity distended with air during the entire procedure in order to insure good visualization."…”

Section: Continued Use and Abuse Of Air In Later Twentieth Century Lamentioning

confidence: 99%

Incidental historiographic faux pas of venous air embolism in laparoscopy, reviewed critically: humanum est errare

Kumar

Sudrania

2018

Int Surg J

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Historiographic antecedents about ambient air (AA) for embolism in operative laparoscopy (OL) are critically reviewed to decipher its representation; for its immense clinical and economic implications. Rumours of air embolism (AE) in beginning of twentieth century were based on rampant use of air tamponade in abdomen and chest for tuberculosis in absence of definitive treatment. News of AE in head, neck, dental and other open surgeries also compounded negative image of air for embolism. Resultant antiair heresy continued in medical press globally bereft of actual knowledge of etiopathophysiology of AE or gas embolism and biomechanics of pneumoperitoneum (PP). This incidental blemish was extended to OL also with divergent etiopathophysiology even when gas used was or is other than air, e.g., CO2, N2O, or O2, etc in PP and none of them are similar to each other in physical or chemical characters.

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The technique of peritoneoscopy

McBrien¹

1971

Journal of British Surgery

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Peritoneoscopy as an aid to diagnosis

Cited by 6 publications

References 6 publications

Highly selective vagotomy without a drainage procedure in the treatment of duodenal ulcer

Highly selective vagotomy without a drainage procedure in the treatment of duodenal ulcer

Incidental historiographic faux pas of venous air embolism in laparoscopy, reviewed critically: humanum est errare

The technique of peritoneoscopy

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