The canine pancreas-duodenum has been perfused for 3 h with a membrane oxygenator, a pulsatile pump and a heat exchanger at a temperature of 37 °C. Among the criteria used in this study, the insulin output into the venous blood in response to glucose administration, as well as pancreas secretion after secretin stimulation were those found to be the most reliable indicators as to the viability of the pancreas. This is further supported by an average oxygen consumption of 0.77 ml O2/100 g at a constant flow of 80 ml/min and a perfusion pressure of 75 mm Hg. The pressure/flow relationship as for any other perfused organ was a safe indicator as to the viability of the perfused pancreas. The functional viability correlated with our anatomical findings.
To assess the results of proximal gastric vagotomy (PGV) in the definitive treatment of perforated duodenal ulcers, a prospective study was carried out comparing PGV in association with omental patch suture (PGV + S) with the simple omental patch suture procedure (S). The PGV + S series consisted of 38 consecutive patients with perforated duodenal ulcer and the S series consisted of 38 survivors of a similar series of 41 consecutive patients. Surgical mortality was zero in the PGV + S series. The patients were followed up for 1 to 7 years. No cases of dumping or diarrhoea were observed. Thirty-three patients in the PGV + S series (87 per cent) were classified as Visick grade I and only two (5 per cent) as Visick grade IV. In contrast, 11 patients (29 per cent) were Visick grade I and 22 (58 per cent) were Visick grade IV in the S series. Recurrent ulcer was detected endoscopically in 58 per cent of the patients who had been treated with simple suture and in only 5 per cent after suture plus PGV. PGV is a safe operation with a negligible morbidity rate and with a significant rate of effective control of ulcer disease. Depending on the general condition of the patient and on the surgeon's skill, it appears preferable to treat not only the acute perforation but also the ulcer disease by PGV.
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