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Which Operation for Chronic Duodenal Ulcer?

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Abstract

THERE is strong evidence to support the theory that duodenal ulcer is the result of gastric hypersecretion. The two known factors that increase secretion of hydrochloric acid in the stomach are: (1) vagal stimulation from the higher centers, and (2) hormonal stimulation from the mucosa of the gastric antrum. In the patients whose ulcer symptoms cannot be controlled by medical treatment, operation may be necessary. An “ideal” operation for duodenal ulcer, from a physiologic standpoint, would eradicate or neutralize both sources of stimulation. Vagus resection with resection of the antrum theoretically should be the ideal operation if it could be used safely in every patient requiring surgical treatment for ulcer.

Unfortunately, there is as yet no universally applicable operative procedure for chronic duodenal ulcer. Instead, there is a choice of three operations, any one of which may give an excellent result in one patient while failing in another.

The surgeon may select from the following:

  1. Subdiaphragmatic vagus resection with posterior gastrojejunostomy (“Vagotomy with gastroenterostomy”).

  2. Subdiaphragmatic vagus resection with conservative gastric resection (“Vagotomy with hemigastrectomy”).

  3. Radical subtotal gastric resection (Removal of three-fourths or more of the stomach).

There are three potential disadvantages that apply in varying degrees to each of these procedures: (1) risk of operative fatality; (2) recurrent ulceration; (3) disabling postoperative sequellae.

Risk of operative fatality. No surgeon is blind to the importance of calculating risk in operations of election, and, unless the result will justify it, no patient will knowingly submit to an operation that . . .


 

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