Review of elective surgical treatment of chronic duodenal ulcer

Abstract

This article is a review of 20 clinical trials of various forms of elective surgical treatment of chronic duodenal ulcer conducted between 1964 and 1975, some of them prospective and others retrospective in nature. Comparisons have been made of the results following truncal vagotomy with drainage, truncal vagotomy with antrectomy, and partial gastrectomy. Additionally, selective vagotomy and truncal vagotomy have been compared in some studies and various forms of drainage, such as pyloroplasty and gastrojejunostomy, have been compared in others. In general, the results of all current forms of elective surgery for chronic duodenal ulcer have been very good, and the differences among the effects of the various procedures have been small. There have been no significant differences in the mortality rates associated with the several operations when they have been performed electively. The rate of ulcer recurrence and incidence of diarrhea have been somewhat higher after truncal vagotomy with drainage, whereas the frequency of dumping and amount of weight loss have been somewhat greater after all forms of gastric resection. Selective vagotomy appears to be associated with less frequent and severe diarrhea than does truncal vagotomy. There have been no apparent differences in the results of the various drainage procedure that have been combined with vagotomy. Highly selective vagotomy without drainage, the most recent operation for duodenal ulcer, has resulted in the lowest incidence of post-operative side effects of any surgical procedure in current use. However, the frequency of ulcer recurrence after this therapeutic measure remains to be determined by long-term studies.

Parietal cell vagotomy: Experience with 114 patients with prepyloric or duodenal ulcer

“…This is comparable with other reports in the literature [22][23][24][25] and indicates a satisfactory operative procedure. The morbidity of vagotomy and drainage or gastrectomy with particular reference to vomiting, diarrhea, dumping, and weight loss has been documented by our unit [26] and others [27][28][29][30]. These complications, when severe, frequently do not respond to treatment [14,20,25,31,32].…”

Obstructive Gastric Pseudotumor Caused by Cytomegalovirus in an AIDS Patient: A Case Report and Review of Surgical Treatment

“…We found in the medical literature 1 report of just 5 cases of gastric pseudotumor by CMV, of which, only 3 cases were reported causing stenosis by the lesion [ 10 ]. Kelesidis et al described a case of duodenal pseudotumor solved by oral treatment with valganciclovir and reported another 14 cases of CMV pseudotumor in other parts of the gastrointestinal tract in their patients [ 20 ]. They cautiously concluded that this successful treatment with complete resolution of CMV’s pseudotumor in their HIV immunosuppressed patient with medication was a unique case in the literature.…”

“…Surgical treatment for duodenal stenosis, which can be caused by malignancy, peptic ulcer, or other specific agents, may involve procedures with surgical resection like partial gastrectomy or bypass techniques like pyloroplasty. Bypass surgery can be done by several approaches as described by Heineke-Mikulicz, Finney, Jaboulay, Finsterer-Bancroft, as well as gastroenteroanastomosis [ 17 – 20 ].…”

Asymptomatic free intraperitoneal gas with duodenal stenosis

“…First, in accordance with a previous report [2], selective proximal vagotomy was performed to reduce postoperative gastric acid secretion. Next, for prevention of gastroesophageal reflux, Toupet fundoplication was carried out.…”

“…Perforations related to peptic ulcer disease are most common among benign disorders, while carcinoma is the most prevalent malignant condition. Overall, duodenal or gastric ulcer is the most frequent cause of perforation [1,2]. Accompanying symptoms usually include epigastric pain, abdominal distention, and fever that are suggestive of acute abdomen, a condition requiring emergent surgical intervention.…”