Surgery for Chronic Duodenal Ulcer: Comparison of Results with Vagotomy–Posterior Gastrojejunostomy and with Vagotomy–Hemigastrectomy
IN recent years our understanding of the advantages and the disadvantages of certain standard elective operations for chronic duodenal ulcer has improved. As a consequence, our ability to select the “best” operation for a patient deserving surgery is steadily improving. However, since it is unlikely that a single operation ever will prove suitable for every candidate for surgery for chronic duodenal ulcer, a continuing analysis of results of the various operations currently in use would seem to be in order. The report presented here is an evaluation of a personal series of 200 patients, 100 of whom underwent vagotomy—posterior gastrojejunostomy, and 100 of whom underwent vagotomy—hemigastrectomy for chronic duodenal ulcer, during the years 1950 through 1957. The series is consecutive for the operations performed except as noted in the tables; one patient was lost to follow-up.
Operations Currently Used
Partial gastrectomy for chronic duodenal ulcer probably is still the most widely used operation in the country at large, as it was shown to be in Ohio by a survey1 performed several years ago. In general, the amount of stomach removed governs the effectiveness of the operation as well as the severity of the sequelae. The more stomach that is removed, the less likely is there to be recurrent ulceration, but the more likely are there to be symptomatic weight-loss and the dumping syndrome.
Hospital mortality rates disclosed in the survey1 varied from 0 to 7.8 per cent, averaging about 5 per cent for the State of Ohio. A . . .