The subject of the treatment of intractable duodenal ulcer is controversial. Some still believe that radical gastric resection is the treatment of choice, whereas others prefer the more conservative procedure of vagotomy combined with pyloroplasty or gastroenterostomy. Our reasons for preferring transabdominal vagotomy, coupled with a conservative operation to afford drainage of the denervated stomach, are based on an experience of only twenty-two months, but since the initial results following vagotomy have been superior to those obtained by any other method of treatment we believe that we are justified in resorting to this operation when medical treatment proves ineffective.
At least 85 per cent of the patients we see with duodenal ulcer make satisfactory progress on medical management. The patients who are being subjected to vagotomy are those with intractable complications of duodenal ulcer which require surgical intervention. Since transabdominal vagotomy has proved safer and more effective than gastric resection and since removal of three-fourths or more of the stomach is an irreversible procedure which cannot be altered even if it produces incapacitating symptoms, it would appear that vagotomy is the conservative method of treatment and that gastric resection is unnecessarily radical.
Duodenal ulcer is a disease which causes much distress but rarely threatens life. Since it is not a disease which carries with it a high mortality rate, operations which entail a significant risk and a high morbidity are not justified in its treatment.
A mortality rate of 2.1 per cent for subtotal gastrectomy for duodenal ulcer has been. . .