Surgical Treatment of Benign Peptic Ulcer

An evaluation and comparison of the early and late results of standardized Polya gastrectomy.

“…Brookes, Waterhouse, and Thorn (1960) found that the majority of post-operative deaths were due to leaking suture lines, respiratory and cardiovascular causes, and that, with the exception of the former, the mortality increased with age. Their findings are in accordance with the experience of others (Armstrong and Penick, 1960;Everson, Hutchings, Eisen, and Witanowski, 1957). A leaking duodenal stump is probably the commonest intraabdominal cause of post-operative death.…”

A clinical appraisal of the treatment of chronic duodenal ulcer by vagotomy and gastric drainage operation

“…Statistics compiled by the Committee on Peptic Ulcer of the American Gastroenterological Association (Sandweiss et al, 1952) revealed a recurrence of ulcer symptons in 4.3% of patients after subtotal gastrectomy. This is similar to the recurrence rate of 4.2% after subtotal gastrectomy recently reported by Armstrong and Penick (1960). Brooks and Moore (1953) found a recurrence rate of 13% after vagotomy alone and Sandweiss et al (1952) have reported even higher recurrence rates following this procedure.…”

“…Only 6 % of our patients developed symptoms consistent with the dumping syndrome and in only one case was this of even moderate severity. These results compare favourably with a reported 11 % to 33% incidence of the dumping syndrome after subtotal gastrectomy (Hayes, 1955;Jordan, 1958;Armstrong and Penick, 1960) and of 23.1 % after hemigastrectomy and vagotomy (Edwards et al, 1957).…”

“…Even more significant is the fact that of the 13 patients who lost weight only two lost more than one stone, and in none was weight loss a serious problem. In contrast, reported results following subtotal gastrectomy indicate an approximate 40% incidence of weight loss (Muir, 1949;Ivy, Grossman, and Bachrach, 1950); in about 18 % to 22 % (Muir, 1949;Armstrong and Penick, 1960), the weight loss exceeded one stone. Excessive weight loss may also be a problem after hemigastrectomy and vagotomy.…”

Treatment of Duodenal Ulcer by a 50% Gastric Resection

“…All the operations were done by one of us (D.C. C.) in the belief that the standard three-quarters gastrectomy is both unnecessary and undesirable as a means of lowering the gastric acidity. The objection to any more limited operation has been the high recurrentulcer rate which Armstrong and Penick (1960) reported on as being as high as 10.9% when only 65% of the stomach was removed. It is our thesis that if the majority of the short gastric arteries are tied (along with the usual arterial ligations) the acidity is so effectively and permanently reduced that it is unnecessary to do an extensive resection.…”