Recurrent Peptic Ulcer

Stabile, Bruce E.; Passaro, Edward

doi:10.1016/s0016-5085(76)80415-5

Cited by 98 publications

(27 citation statements)

References 108 publications

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“…extensively reviewed in the literature, the problems of the investigation and treatment of recurrent ulceration have received less attention and clear guidelines for the surgical therapy have not been defined (Stable and Passaro, 1976). Recurrent ulceration after vagotomy and a drainage procedure is often associated with the incomplete division of nerves (Dragstedt et al, 1947), the intact trunk in these circumstances usually being large (Clark, 1964).…”

mentioning

confidence: 99%

Revagotomy for recurrent peptic ulceration

Taylor

Pearson

Torrance

1977

Journal of British Surgery

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A review has been made of 59 patients with recurrent peptic ulceration after incomplete vagotomy. Eighteen transthoracic procedures were performed, the remainder having abdominal revagotomy. An antrectomy was also carried out in 10 of these patients. An intact posterior nerve trunk was the most common operative finding and when either an anterior trunk or nerve strands only were present there was less likely to be an early positive insulin response (P = 0.033). Following incomplete vagotomy a longer period of symptomatic relief is obtained when gastro-enterostomy rather than pyloroplasty is used as the drainage (P less than 0.01). Completing the vagotomy by the abdominal route gave superior results to transthoracic revagotomy (P = 0.0015), the former procedure without antrectomy having no associated mortality in this series. Although the results of revagotomy and antrectomy are as good as those of transabdominal revagotomy alone, we recommend the latter more conservative treatment for recurrent ulceration after incomplete vagotomy.

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mentioning

confidence: 99%

Revagotomy for recurrent peptic ulceration

Taylor

Pearson

Torrance

1977

Journal of British Surgery

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“…Vor Einffihrung der H2-Rezeptorantagonisten war die konservative Behandlung eines Rezidivulkus nach chirurgischer Ulkustherapie von einer hohen Komplikationsrate und h/iufigen Rerezidiven gekennzeichnet [23]. Seit 1978 hat sich diese Situation ge/indert.…”

Section: Patientengutunclassified

“…Insbesondere Patienten mit einem Rezidiv nach SPV werden in der fiberwiegenden Zahl erfolgreich mit Hilfe der H2-Antagonisten therapiert [24,26]. Die Operationsletalit/it der alleinigen Resektion betrug vor 10 bis 15 Jahren noch bis zu 10% [3,7,23,25]. Einer chirurgischen Therapie bediirfen meist nur die komplizierten Rezidive.…”

Section: Patientengutunclassified

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

Arlt

Peiper

Winkeltau

et al. 1993

Langenbecks Arch Chiv

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The outcome of Billroth I hemigastrectomy for complicated recurrent ulcers after proximal selective vagotomy (PSV) for duodenal ulcer was analyzed in a retrospective study of 15 patients followed up for 15-81 months (mean 3.8 years) postoperatively. Bleeding was reported in 4, stenosis in 5, penetration in 3, perforation in 1 and refractory ulcer in 2 cases. None of the patients died during revision surgery, and none developed ulcer recurrence. In 4 patients complications were seen, including bleeding requiring relaparotomy (1) and subhepatic hematoma (3). In 12 patients (80%) a good or excellent result (Visick I/II) was seen at follow-up. Reasons for Visick III or Visick IV classification were reflux esophagitis grades I and II in 2 cases and refractory dyspeptic symptoms in 1 case. Distal gastric resection with a Billroth I anastomosis for complicated recurrent ulcer after PSV proved to involve only low morbidity and to effect reliable prophylaxis of ulcer recurrence in the long term.

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“…Stabile u. Passaro [14] ermittelten in ihrer grogen Sammelstatistik eine ulcusbedingte Letalitat von 10,8 ~ und zusatzlich eine Ulcuspersistenz bzw. Unter konservativer Behandlung ist die Zahl der Therapieversager sehr grog, Komplikationsrate und Letalitat sind hoch.…”

Section: Diskussionunclassified

“…Wird wegen praparatorischer Schwierigkeiten bei der Nachresektion auf die zusatzliche Vagotomie verzichtet, so erh6ht sich die Rate der erneuten Ulcusrezidive, die mit 5-20~ [2,7,14,19] angegeben wird betrachtlich. Diese Korrektureingriffe sind operationstechnisch schwierig und langwierig, das Risiko der Verletzung von Nachbarorganen ist groB, entsprechend hoch ist die Rate der intra-und postoperativen Komplikationen.…”

Section: Diskussionunclassified

Ergebnisse der thorakalen Vagotomie bei Billroth I-Anastomosenulcus

Kieninger

Breucha

1982

Langenbecks Arch Chiv

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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.

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Recurrent Peptic Ulcer

Cited by 98 publications

References 108 publications

Revagotomy for recurrent peptic ulceration

Revagotomy for recurrent peptic ulceration

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

Ergebnisse der thorakalen Vagotomie bei Billroth I-Anastomosenulcus

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