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Acute Massive Duodenal Ulcer Hemorrhage: Direct Suture Control and Vagotomy Pyloroplasty

Acute Massive Duodenal Ulcer Hemorrhage: Direct Suture Control and Vagotomy Pyloroplasty Abstract Heuer1 has stated that in bleeding duodenal ulcer the primary object of surgery is to control hemorrhage and to save life. Subtotal gastrectomy with removal of the ulcer is generally accepted as being the only procedure available that can be relied upon to do this, despite the formidable risk under these trying circumstances. Dragstedt's2 recommendation of vagotomy as a less radical and more physiologic procedure for dealing with ulcer diathesis led us to begin using it exclusively, together with pyloroplasty, for surgical treatment of duodenal ulcer. Since 1946 we have employed this in nearly 300 patients, with only 3 surgical deaths and with 94% satisfactory long-term results. Early in our experience3-5 the thought occurred to us that in the case of bleeding duodenal ulcer perhaps direct suture of the bleeding point, previously considered unreliable, might now be depended upon to control bleeding, if combined with vagotomy to References 1. Heuer, G. J.:: The Surgical Aspects of Hemorrhage from Peptic Ulcer , New Engl. J. Med. 235: 777-783, 1946.Crossref 2. Dragstedt, L. R., and Owens, F. M., Jr.: Supradiaphragmatic Section of Vagus Nerves in Treatment of Duodenal Ulcer , Proc. Soc. Exp. Biol. Med. 53:152, 1943.Crossref 3. Dorton, H. E., and Webb, J. G.: Vagotomy and Pyloroplasty, the Physiologic Treatment for Duodenal Ulcer , J. Kentucky Med. Ass. 49:139-145, 1951. 4. Dorton, H. E.; Webb, J. G., and Royalty, D. M.: A Simple Safe Solution to the Bleeding Ulcer Problem , J. Kentucky Med. Ass. 50:16, 1952. 5. Dorton, H. E.: Vagotomy for Bleeding Duodenal Ulcer , J. Kentucky Med. Ass. 56:855, 1958. 6. Weinberg, J. A.: Personal communication to the author, May, 1957. 7. Westland, J. C.; Movius, H. J., and Weinberg, J. A.: Emergency Surgical Treatment of the Severely Bleeding Duodenal Ulcer , Surgery 43:897, 1958. 8. Smith, G. K., and Farris, J. M.: Rationale of Vagotomy-Pyloroplasty in Bleeding Ulcer , J.A.M.A. 166:878, 1958.Crossref 9. Farris, J. M., and Smith, G. K.: Vagotomy and Pyloroplasty—A Solution to the Management of Bleeding Duodenal Ulcer , Ann. Surgery 152: 416, 1960. 10. Lewison, E. F.: Bleeding Peptic Ulcer: A Collective Review , Int. Abstr. Surg. 90:1, 1950. 11. Dorton, H. E.: Vagotomy Pyloroplasty and Suture—A Safe and Effective Remedy for the Duodenal Ulcer That Bleeds , Ann. Surg. 153:378 ( (March) ) 1961.Crossref 12. Stewart, J. D.; Hale, H. W., Jr., and Hix, J. E.: Gastric Resection for Peptic Ulcer in Poor-Risk Patients , New York J. Med. 49:2911, 1949. 13. Hoerr, S. O., and Dunphy, J. E.: Indications for Emergency Operations in Severe Hemorrhage from Gastric or Duodenal Ulcer , Surgery 24:231-238, 1948. 14. Dorton, H. E.: A Multipurpose Gastrostomy Tube , Surg. Gynec. Obstet. 112:120, 1961. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Acute Massive Duodenal Ulcer Hemorrhage: Direct Suture Control and Vagotomy Pyloroplasty

Archives of Surgery , Volume 83 (3) – Sep 1, 1961

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References (15)

Publisher
American Medical Association
Copyright
Copyright © 1961 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1961.01300150102013
Publisher site
See Article on Publisher Site

Abstract

Abstract Heuer1 has stated that in bleeding duodenal ulcer the primary object of surgery is to control hemorrhage and to save life. Subtotal gastrectomy with removal of the ulcer is generally accepted as being the only procedure available that can be relied upon to do this, despite the formidable risk under these trying circumstances. Dragstedt's2 recommendation of vagotomy as a less radical and more physiologic procedure for dealing with ulcer diathesis led us to begin using it exclusively, together with pyloroplasty, for surgical treatment of duodenal ulcer. Since 1946 we have employed this in nearly 300 patients, with only 3 surgical deaths and with 94% satisfactory long-term results. Early in our experience3-5 the thought occurred to us that in the case of bleeding duodenal ulcer perhaps direct suture of the bleeding point, previously considered unreliable, might now be depended upon to control bleeding, if combined with vagotomy to References 1. Heuer, G. J.:: The Surgical Aspects of Hemorrhage from Peptic Ulcer , New Engl. J. Med. 235: 777-783, 1946.Crossref 2. Dragstedt, L. R., and Owens, F. M., Jr.: Supradiaphragmatic Section of Vagus Nerves in Treatment of Duodenal Ulcer , Proc. Soc. Exp. Biol. Med. 53:152, 1943.Crossref 3. Dorton, H. E., and Webb, J. G.: Vagotomy and Pyloroplasty, the Physiologic Treatment for Duodenal Ulcer , J. Kentucky Med. Ass. 49:139-145, 1951. 4. Dorton, H. E.; Webb, J. G., and Royalty, D. M.: A Simple Safe Solution to the Bleeding Ulcer Problem , J. Kentucky Med. Ass. 50:16, 1952. 5. Dorton, H. E.: Vagotomy for Bleeding Duodenal Ulcer , J. Kentucky Med. Ass. 56:855, 1958. 6. Weinberg, J. A.: Personal communication to the author, May, 1957. 7. Westland, J. C.; Movius, H. J., and Weinberg, J. A.: Emergency Surgical Treatment of the Severely Bleeding Duodenal Ulcer , Surgery 43:897, 1958. 8. Smith, G. K., and Farris, J. M.: Rationale of Vagotomy-Pyloroplasty in Bleeding Ulcer , J.A.M.A. 166:878, 1958.Crossref 9. Farris, J. M., and Smith, G. K.: Vagotomy and Pyloroplasty—A Solution to the Management of Bleeding Duodenal Ulcer , Ann. Surgery 152: 416, 1960. 10. Lewison, E. F.: Bleeding Peptic Ulcer: A Collective Review , Int. Abstr. Surg. 90:1, 1950. 11. Dorton, H. E.: Vagotomy Pyloroplasty and Suture—A Safe and Effective Remedy for the Duodenal Ulcer That Bleeds , Ann. Surg. 153:378 ( (March) ) 1961.Crossref 12. Stewart, J. D.; Hale, H. W., Jr., and Hix, J. E.: Gastric Resection for Peptic Ulcer in Poor-Risk Patients , New York J. Med. 49:2911, 1949. 13. Hoerr, S. O., and Dunphy, J. E.: Indications for Emergency Operations in Severe Hemorrhage from Gastric or Duodenal Ulcer , Surgery 24:231-238, 1948. 14. Dorton, H. E.: A Multipurpose Gastrostomy Tube , Surg. Gynec. Obstet. 112:120, 1961.

Journal

Archives of SurgeryAmerican Medical Association

Published: Sep 1, 1961

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