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Measured Subtotal Gastrectomy for Duodenal Ulcer: Size of Resection Versus Ulcer Control and Patient Rehabilitation

Measured Subtotal Gastrectomy for Duodenal Ulcer: Size of Resection Versus Ulcer Control and... Abstract DURING the past 30 years the most common operation for duodenal ulcer has been resection of the distal two thirds to three fourths of the stomach. This procedure, once the standard operation in peptic-ulcer surgery, is now being replaced in many hospitals by vagotomy combined with pyloroplasty or antrectomy. Operations eliminating vagal stimulation probably have a more elegant physiologic rationale to support them1-3; but the loss of enthusiasm for subtotal gastrectomy stems in large part from reports of high ulcer-recurrence rates, poor nutritional results, distressing postprandial symptoms, and relatively high operative morbidity and mortality figures.4-7 The incidence of such complications after subtotal gastrectomy is not uniform, however, and some authors have reported such good operative results that there would seem to be little room left for improvement in an elective procedure, regardless of its physiologic basis.8,9 It seems desirable to determine the reasons behind the disparity in References 1. Moore, F.D.: Surgery in Search of a Rationale: Eighty Years of Ulcerogenic Surgery , Amer J Surg 105:304-312, 1963.Crossref 2. Weinberg, J.A.: Vagotomy and Pyloroplasty in the Treatment of Duodenal Ulcer , Amer J Surg 105:347-351, 1963.Crossref 3. Edwards, L.W., et al: The Surgical Treatment of Duodenal Ulcer by Vagotomy and Antral Resection , Amer J Surg 105:352-360, 1963.Crossref 4. Ordahl, N.B.; Ross, F.P.; and Baker, D.V., Jr.: The Failure of Partial Gastrectomy With Gastroduodenostomy in the Treatment of Duodenal Ulcer , Surgery 38:158-164, 1955. 5. Gobbel, W.G., Jr., and Shoulders, H.H., Jr.: " Gastric Resection " in Postlethwaite, R.W., and James C. Thoroughman (eds.): Results of Surgery for Peptic Ulcer , Philadelphia: W. B. Saunders Co. 1963. 6. Zollinger, R.M., and Ellison, E.H.: Nutrition After Gastric Operations , JAMA 154:811-814, 1954.Crossref 7. Rhea, W.G., Jr.; Killen, D.A.; and Scott, H.W., Jr.: Long Term Results of Partial Gastric Resection Without Vagotomy in Duodenal Ulcer Disease , Surg Gynec Obstet 120:970-974, 1965. 8. Smith, E.T.; Stephenson, W.H.; and Domz, C.A.: Gastric Resection for Duodenal Ulcer , Amer J Surg 106:185-193, 1963.Crossref 9. Welch, C.E., and Rodkey, G.V.: Partial Gastrectomy for Duodenal Ulcer , Amer J Surg 105:338-346, 1963.Crossref 10. Hoar, C.S., Jr.: Radical Subtotal Gastrectomy for Peptic Ulcer Disease. A Clinical and Laboratory Evaluation , Arch Surg 78:384-392, 1959.Crossref 11. Moore, H.G., Jr., and Harkins, H.N.: Critical Evaluation of Billroth I Gastric Resection , Surgery 32:408-425, 1952. 12. Olch, P.D., and Harkins, H.N.: Quantitative Assessment of Extent of Gastric Resection. Comparison of Pattern-Planimeter and Pattern Weight Methods , Surgery 48:655-657, 1960. 13. Visick, A.H.: Measured Radical Gastrectomy. Review of 505 Operations for Peptic Ulcer , Lancet 1:505-510, 551-555, 1948.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Measured Subtotal Gastrectomy for Duodenal Ulcer: Size of Resection Versus Ulcer Control and Patient Rehabilitation

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Publisher
American Medical Association
Copyright
Copyright © 1966 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1966.01320190054012
Publisher site
See Article on Publisher Site

Abstract

Abstract DURING the past 30 years the most common operation for duodenal ulcer has been resection of the distal two thirds to three fourths of the stomach. This procedure, once the standard operation in peptic-ulcer surgery, is now being replaced in many hospitals by vagotomy combined with pyloroplasty or antrectomy. Operations eliminating vagal stimulation probably have a more elegant physiologic rationale to support them1-3; but the loss of enthusiasm for subtotal gastrectomy stems in large part from reports of high ulcer-recurrence rates, poor nutritional results, distressing postprandial symptoms, and relatively high operative morbidity and mortality figures.4-7 The incidence of such complications after subtotal gastrectomy is not uniform, however, and some authors have reported such good operative results that there would seem to be little room left for improvement in an elective procedure, regardless of its physiologic basis.8,9 It seems desirable to determine the reasons behind the disparity in References 1. Moore, F.D.: Surgery in Search of a Rationale: Eighty Years of Ulcerogenic Surgery , Amer J Surg 105:304-312, 1963.Crossref 2. Weinberg, J.A.: Vagotomy and Pyloroplasty in the Treatment of Duodenal Ulcer , Amer J Surg 105:347-351, 1963.Crossref 3. Edwards, L.W., et al: The Surgical Treatment of Duodenal Ulcer by Vagotomy and Antral Resection , Amer J Surg 105:352-360, 1963.Crossref 4. Ordahl, N.B.; Ross, F.P.; and Baker, D.V., Jr.: The Failure of Partial Gastrectomy With Gastroduodenostomy in the Treatment of Duodenal Ulcer , Surgery 38:158-164, 1955. 5. Gobbel, W.G., Jr., and Shoulders, H.H., Jr.: " Gastric Resection " in Postlethwaite, R.W., and James C. Thoroughman (eds.): Results of Surgery for Peptic Ulcer , Philadelphia: W. B. Saunders Co. 1963. 6. Zollinger, R.M., and Ellison, E.H.: Nutrition After Gastric Operations , JAMA 154:811-814, 1954.Crossref 7. Rhea, W.G., Jr.; Killen, D.A.; and Scott, H.W., Jr.: Long Term Results of Partial Gastric Resection Without Vagotomy in Duodenal Ulcer Disease , Surg Gynec Obstet 120:970-974, 1965. 8. Smith, E.T.; Stephenson, W.H.; and Domz, C.A.: Gastric Resection for Duodenal Ulcer , Amer J Surg 106:185-193, 1963.Crossref 9. Welch, C.E., and Rodkey, G.V.: Partial Gastrectomy for Duodenal Ulcer , Amer J Surg 105:338-346, 1963.Crossref 10. Hoar, C.S., Jr.: Radical Subtotal Gastrectomy for Peptic Ulcer Disease. A Clinical and Laboratory Evaluation , Arch Surg 78:384-392, 1959.Crossref 11. Moore, H.G., Jr., and Harkins, H.N.: Critical Evaluation of Billroth I Gastric Resection , Surgery 32:408-425, 1952. 12. Olch, P.D., and Harkins, H.N.: Quantitative Assessment of Extent of Gastric Resection. Comparison of Pattern-Planimeter and Pattern Weight Methods , Surgery 48:655-657, 1960. 13. Visick, A.H.: Measured Radical Gastrectomy. Review of 505 Operations for Peptic Ulcer , Lancet 1:505-510, 551-555, 1948.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Jan 1, 1966

References