Vagotomy and pyloroplasty in the elective treatment of gastric ulcer

Abstract

Vagotomy and pyloroplasty have been used in the elective treatment of gastric ulcer in 72 patients. In 33 patients there was associated duodenal ulcer (G.D.U.). In the other 39 patients (G.U.) there was no evidence of duodenal ulcer. Patients with prepyloric gastric ulcer were excluded. The operative mortality was nil. At an average follow‐up of 3 1/2 years the functional results in the G.U. group were good for 89 per cent of the cases, satisfactory for 5‐5 per cent, and poor for 5‐5 per cent compared with 73, 10, and 17 per cent respectively in the G.D.U. group. Two patients in each group showed recurrent ulcer, an incidence of 5‐4 per cent in the G.U. group and 6‐7 per cent in the G.D.U. group. There is no statistically significant difference in these results. Vagotomy and pyloroplasty appear to comprise a satisfactory treatment for gastric ulcer whether or not the ulcer is associated with duodenal ulcer. The present findings do not support the view that the good results previously reported were due to the inclusion of patients with pre‐pyloric gastric ulcer or with associated duodenal ulcer. Three patients showed malignancy in the ulcer and a further case has been recorded in the total of 102 patients undergoing surgery during the period of the review (an incidence of 4 per cent), underlining the need for biopsy of the ulcer in all cases.

Gastric ulcer treated with ulcerectomy, vagotomy, and drainage

“…Truncal or gastric (selective) vagotomy with drainage and ulcerectomy has earned some advocates in recent years [2][3][4][5][6][7][8][9] while, to our knowledge, a series of patients treated by proximal gastric vagotomy and ulcerectomy without drainage has not yet been reported. Gastric (selective) vagotomy reduces acid production, but increases the factor of retention and perhaps also the tendency to pyloric reflux.…”