Duodenal ulcer stenosis with gastric dilatation. Treatment by vagotomy and pyloroplasty

Obstructing duodenal ulcer

The incidence, pathogenesis, symptoms, roentgenographic, and endoscopic findings of patients with gastric outlet obstruction from a chronic duodenal ulcer have been reviewed. In the experience of many surgeons, including myself, vagotomy and an adequate drainage procedure (Finney pyloroplasty, gastrojejunostomy, or gastroduodenostomy) provide excellent decompression of the obstructed stomach. as well as excellent control of the ulcer disease in most patients. Postvagotomy gastric atony has not been a problem.

Late results of bilateral selective vagotomy and pyloroplasty for duodenal ulcer: 5-9-year follow-up

From July, 1964, to July, 1968, bilateral selective vagotomy and pyloroplasty were performed in 135 patients for duodenal ulcer, without postoperative mortality. Two unrelated deaths occurred during the period of the survey and 2 other patients were lost to follow-up. The remaining 131 patients were followed up for a minimum of 5 years and a maximum of 9 years.

The most frequent symptoms were epigastric fullness, early dumping and mild diarrhoea. Only I case of moderate diarrhoea was observed, and none of severe diarrhoea. Food vomiting, bile vomiting and hypo-glycaemia-like attacks were uncommon. Recurrent duodenal ulcer was proved in 4.6 per cent and highly suspected in 1.5 per cent. Gastric ulcer was proved in 3.1 per cent. Approximately 91 per cent of the patients were classed as having a satisfactory result and 9 per cent were unsatisfactory.

It is concluded that bilateral selective vagotomy is clearly effective in controlling the ulcer diathesis in the long term. In addition, it seems to lessen some of the side-effects of gastric surgery. For these reasons, consideration should be given to its use in the surgical treatment of duodenal ulcer.