Subdiaphragmatic Vagotomy; Indications and Technic
The principle of vagotomy as described by Dragstedt1 has been widely accepted in the treatment of peptic ulcer, and the results up to the present time have been satisfactory. During the past year 50 vagotomies have been performed at Cleveland Clinic Hospital, 6 of these through the thorax and the remainder through the abdomen. With increasing experience the subdiaphragmatic approach has become the procedure of choice and has been used exclusively in the last 27 cases.
In a few (7) of the earlier cases only the anterior vagus was sectioned, but more recently both vagi have been severed below the diaphragm, cither as the sole surgical treatment of peptic ulcer or more often in conjunction with some gastric operation. At first we did not feel justified in relying too much on vagotomy alone, and in many cases, in order to afford added protection against recurrent ulceration, gastric resection was performed along with vagotomy.
In some cases in which resection would have been difficult or dangerous gastroenterostomy was employed. The excellent immediate results obtained by vagotomy and a conservative gastric operation encouraged us to resect fewer stomachs. Recently I have employed pyloroplasty more often than gastroenterostomy in conjunction with vagotomy (table).
Pyloroplasty is the simplest and safest of all the surgical procedures used in the treatment of ulcer. When employed alone its results were not too encouraging, but when pyloroplasty is combined with vagotomy the immediate results in a small group of cases have been excellent. In many instances pyloroplasty is. . .