Preliminary Observations on Hemigastrectomy with Subdiaphragmatic Vagotomy for the Average Case of Chronic Duodenal Ulcer
ABOUT two years ago, it became clear to my colleagues and me that subdiaphragmatic vagotomy with posterior gastroenterostomy was not a completely satisfactory answer to the problem presented by the patient with a “surgical” duodenal ulcer (one for which surgery is indicated). At that time studies showed that 5 per cent of patients followed at least five years required a second operation for ulcer. Although the procedure has a very low mortality rate — in our experience less than one-half of one per cent — the rate of failure seemed too high for us to continue performing this operation for the average elective case. Accordingly, we decided to change to subdiaphragmatic vagotomy with hemigastrectomy. This promised a more reliable relief of the ulcer diathesis, yet preserved enough stomach to avoid most of the ills common to the postgastrectomy state. However, in an effort to maintain a low mortality rate, comparable to that of the simpler operation, we also decided to continue to do vagotomy with posterior gastroenterostomy in those patients whose condition was such that it seemed that gastric resection would appreciably increase the surgical risk. About four of every five vagotomized patients have had a partial resection since this policy was started, and the other one of every five, a gastroenterostomy.
Although many years will have to pass before the program can be finally evaluated, definite impressions already have been gained. Since this program was adopted there has been no evidence, clinical or otherwise, of recurrent ulceration in any of our. . .