An evaluation and comparison of the early and late results of standardized Polya gastrectomy.

Kemp, Donald R.

doi:10.1136/gut.8.2.151

Cited by 13 publications

(3 citation statements)

References 26 publications

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“…Weight loss was observed in 16.5% of our patients, 14% losing less than 5 kg. This figure agrees with those of Kemp [8] who found an 18% incidence of weight loss, and of McKeown [3] who found that 12% of his patients lost weight. We agree with Hillman's proposal [9] that the cause of the weight loss is probably diminished food intake, once malabsorption and pancreatic insufficiency have been ruled out.…”

Section: Discussionsupporting

confidence: 91%

Long‐term results of subtotal gastrectomy for duodenal ulcer

et al. 1980

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Long-term clinical and metabolic results of subtotal gastrectomy for duodenal ulcer in 133 patients are reported. The operative procedure consisted of a 4/5 gastric resection with a retrocolic no-loop Hoffmeister anastomosis. After detailed clinical and metabolic assessment, 84% of the patients were graded Visick grades I and II. Postgastrectomy symptoms were few, only mild or moderate in intensity, and were not disabling in any of the cases. No diarrhea or vomiting was noted. Weight loss was observed in 16% of the patients, 14% losing less than 5 kg. Diarrhea or malabsorption was not encountered in the entire series. The incidence of anemia was 5.5%. None of the hemoglobin levels were below 10.5 g/dl. All cases of anemia were microcytic, hypochromic, iron deficient. There were no hematological or clinical signs suggestive of macrocytic anemia in the entire series. Plasma protein, calcium, and phosphorus levels were within normal limits. All patients were free of clinical complaints and history suggestive of bone disease. It is believed that the low morbidity and the few and mild metabolic sequelae are due to the type of anastomosis used.Much has been written in the past 3 decades about the results of various operations for duodenal ulcer, yet no single procedure has achieved general acceptance. In particular, there are divergent opinions about the results of subtotal gastrectomy. Of all the arguments that have helped bring gastric resection into disfavor in the treatment of duodenal ulcer, poor nutrition and metabolic sequelae have been the strongest. Recently, there have been a number of well-conducted studies [1][2][3][4] that have contradicted the objections to subtotal gastrectomy. Nevertheless, skepticism about this procedure remains. This is a report of a study that was undertaken to evaluate the long-term clinical, metabolic, and nutritional results of subtotal gastrectomy in a series of 133 patients. It is not the conclusion of this report that resection is the procedure of choice for the treatment of duodenal ulcer. We believe that whenever resection is considered, it should be combined with vagotomy. The report stresses the merit of the Hoffmeister no-loop retrocolic type of anastomosis, which we believe is responsible for the relatively few and mild postprandial symptoms and nutritional sequelae. MethodsDuring the period [1953][1954][1955][1956][1957][1958][1959][1960][1961][1962][1963][1964][1965][1966][1967][1968] 230 patients underwent subtotal gastrectomy for duodenal ulcer. Of these, 8 patients died postoperatively, 44 died subsequently of causes unrelated to the operation, and 45 patients were untraceable. The remaining 133 patients, 27 females and 106 males, were followed up. The minimum follow-up period was 5 years and the maximum was 20 years.The operative procedure consisted of a 4/s Hoffmeister gastrectomy with a retrocolic no-loop anastomosis. Much attention was directed to shortening the afferent duodenal loop by dividing the ligament of Treitz and pulling the doudenum distally. In this ...

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Section: Discussionsupporting

confidence: 91%

Long‐term results of subtotal gastrectomy for duodenal ulcer

et al. 1980

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“…The patients in the present study are derived from a period in which Billroth II gastrectomy had become generally accepted [8][9][10][11][12]. Later studies showed considerable sequelae [13][14][15] appearing in the early postoperative years, but only few have described the long-term (i.e., 20-30 years) results [16][17][18][19][20]. The operative complications and mortality rate were not higher than in other gastrectomy studies [9,18,19,[21][22][23], but these should be compared to less extensive procedures such as vagotomy [1,24].…”

Section: Discussionmentioning

confidence: 99%

Twenty‐five years after Billroth II gastrectomy for duodenal ulcer

Fischer¹

1984

World j. surg.

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One thousand twenty‐five patients underwent a Billroth II resection for duodenal ulcer between 1948 and 1956. The operative mortality rate was 2.4%. At follow‐up between 22 and 30 years later, 522 had died and 423 patients were traced. Recurrent ulcer appeared in 2.6% of the cases. Postgastrectomy symptoms occurred with the following frequency: dumping 10%, diarrhea 5%, vomiting 7%, and pain 4%. Anemia developed in 18%, hypoalbuminemia and hypocalcemia in 40 and 15%, respectively. Eleven percent had lost more than 10 kg in weight. Tuberculosis was found in 3% of the cases. While 90% of the patients were satisfied with the result, 10% were failures. The overall mortality rate was significantly increased because of suicide. Gastric carcinoma was the cause of death no more often than expected.

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“…Patients vary considerably in the periodicity of their ulcer dyspepsia, and any individual patient may himself vary in the frequency and severity of relapses from year to year. From large reported series such as those of Thoroughman & Ginglich (1963) and Kemp (1967), it is evident that the majority of duodenal ulcer patients coming to operation have had symptoms for between 5 and 10 years, and an appreciable proportion have a history going back more than 20 years. Factors other than simply the length of time over which symptoms have persisted are generally taken into consideration in reaching a decision for operation in a particular patient.…”

Section: Indications For Elective Operationmentioning

confidence: 99%

The surgical treatment of peptic ulcer

Gillespie

1968

Postgraduate Medical Journal

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An evaluation and comparison of the early and late results of standardized Polya gastrectomy.

Cited by 13 publications

References 26 publications

Long‐term results of subtotal gastrectomy for duodenal ulcer

Long‐term results of subtotal gastrectomy for duodenal ulcer

Twenty‐five years after Billroth II gastrectomy for duodenal ulcer

The surgical treatment of peptic ulcer

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