Clinical and radiological study of vagotomy and gastric drainage in the treatment of pyloric stenosis due to duodenal ulceration.

Ellis, Harold; Starer, F.; Venables, C W; Ware, C. C.

doi:10.1136/gut.7.6.671

Cited by 21 publications

(4 citation statements)

References 8 publications

(10 reference statements)

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“…Postoperative gastric retention did not occur in any of the patients and none required postoperative gastric aspiration. All had good functional results, and subsequent barium meal examinations showed return of the dilated stomachs to normal size and tone with satisfactory emptying [8]. At present, our total has reached 80 patients and, to date, apart from 1 patient who developed a stomal ulcer and required subsequent conversion to partial gastrectomy, the results have been uniformly satisfactory.…”

Section: Surgical Treatmentmentioning

confidence: 72%

Pyloric stenosis complicating duodenal ulceration

Ellis

1987

World j. surg.

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Pyloric stenosis would be better termed gastric outlet obstruction but popular usage favors the former title. The most common cause in adults is a stenosing chronic duodenal ulcer, but differential diagnosis must be made clinically, radiologically, and endoscopically from other causes, particularly carcinoma of the gastric antrum. Metabolic disturbances due to fluid and electrolyte loss are not common but, if present, require correction by intravenous replacement therapy. The condition is becoming less common due to the overall decline in incidence of duodenal ulcer in the Western world and the more effective medical treatment of duodenal ulcer with H2antagonists. It is still common, however, in many parts of the Third World. Treatment is invariably surgical but medical preoperative preparation is required. Vagotomy combined with drainage gives excellent results.

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Section: Surgical Treatmentmentioning

confidence: 72%

Pyloric stenosis complicating duodenal ulceration

Ellis

1987

World j. surg.

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“…Seventy-four per cent of patients were found to have achieved perfect clinical results after HSV, whereas only 44% of patients after TV + D did so: 94 % of patients had good-or-excellent results (Visick grades 1 + 2) after HSV, compared with only 74 % of patients after TV + D. These findings, while they might appear at first sight to give an unfair account of the clinical results to be expected after TV + D (Feggetter and Pringle, 1965;Ellis et al, 1966), are, in fact, very similar to those which were reported previously from Leeds after HSV and TV + D when these procedures were used in the treatment of patients with uncomplicated duodenal ulceration (Goligher et al, 1968;Amdrup et al, 1974). The comparison between HSV and TV + D in this study is greatly weakened, however, by the facts that patients were not allotted in random manner to one or other of the operative procedures and that the length of follow-up of patients after HSV (24 months) was considerably shorter than that of patients who had undergone TV + D (41 months).…”

Section: Discussionmentioning

confidence: 98%

Highly selective vagotomy plus dilatation of the stenosis compared with truncal vagotomy and drainage in the treatment of pyloric stenosis secondary to duodenal ulceration.

McMahon¹,

Greenall²,

Johnston³

et al. 1976

Gut

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SUMMARY Twenty-three consecutive patients with duodenal ulceration complicated by pyloric stenosis who came under the care of one surgeon were treated by highly selective vagotomy (HSV) combined with digital dilatation ofthe stenosis through a gastrotomy. No form of drainage procedure was used. Thus the antral 'mill' and the pyloric sphincter were left intact. Since the stenosis is usually distal to the pylorus rather than truly pyloric such dilatation does not damage the pyloric ring, although it may on occasion lead to perforation of the first part of the duodenum. The subsequent progress of these patients was compared with that of a similar, consecutive series of 23 patients with pyloric stenosis who were treated by truncal vagotomy with a drainage procedure by other surgeons on the same surgical unit. Patients were followed up for between four months and five years. The clinical assessment was carried out in 'blind' fashion at a special gastric follow-up clinic. No evidence of recurrent ulceration was found in either group of patients. Two patients from each group subsequently came to reoperation for the relief of gastric stasis. Twenty-two of the 23 patients (96%) who had undergone HSV plus dilatation eventually achieved a good-to-excellent clinical result (Visick grades 1 + 2), whereas only 17 of the 23 patients (74 %) who had undergone truncal vagotomy with drainage achieved such a result. The main clinical difference between the two groups was that side effects such as diarrhoea and abdominal pain or discomfort were more common after vagotomy with drainage than after HSV. These results bear witness to the remarkable propulsive powers of the gastric antrum after HSV, which were evidently sufficient to overcome any tendency to re-stenosis in more than 90 % of patients. The 9 % incidence of failure due to re-stenosis could perhaps be avoided if a small duodenoplasty were performed instead of simple digital dilatation. The results support the hypothesis that damage to the antral mill and pyloric sphincter can be avoided in the course of operations for 'pyloric' stenosis secondary to duodenal ulceration. Avoidance of the drainage procedure is of benefit to the patient, just as it is in patients who have duodenal ulceration without stenosis.When pyloric stenosis is secondary to duodenal stenosis develops, the stomach compensates for the ulceration the adjective 'pyloric' is not quite accurate, obstruction at its outlet by means of hypertrophy of because in most patients the actual site of narrow-its muscular wall and by forceful peristalsis in the ing is beyond the pylorus in the first part of the antrum. Eventually, as stenosis becomes increasingly duodenum. This distinction is important, because it severe, the stomach gives up the unequal struggle, means that the pyloric sphincter and the antral mill becoming dilated and atonic. remain undamaged by the fibrosis, oedema, and Although truncal vagotomy with a drainage spasm which combine to create the stenosis. As procedure

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“…Given the likelihood of spontaneous resolution and the disappointing results of early reoperation, there seems to be little indication for early intervention in the majority. A contrast orted5, 7,9,[13][14][15] study can still be justified, however, as it may exclude a mechanical problem such as small bowel obstruction or intussusception of the stoma.…”

Section: Discussionmentioning

confidence: 99%

Delayed return of gastric emptying after gastroenterostomy

Woods

Mitchell

1989

British Journal of Surgery

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A retrospective study of patients having gastroenterostomies was undertaken to identify predictive factors for the development of postoperative delayed return of gastric emptying (DRGE). A total of 322 consecutive patients underwent 324 gastroenterostomies; 35 experienced delayed return of gastric emptying. Regression analysis demonstrated preoperative obstruction to be the most significant factor (P less than 0.001). Vagotomy was not an independent variable. Age, sex, size of stoma, anastomotic technique, albumin and experience of the operator were not significant factors. Gastroenterostomy in the presence of 'gastric atony' was likely to produce DRGE. In all, 86 per cent of cases resolved spontaneously. Only one case of DRGE was found to have a mechanical cause. Most patients were supported by parenteral nutrition but, with a knowledge of the identified risk factors, more thought could be given to establishing a route for jejunal feeding at the time of surgery.

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Clinical and radiological study of vagotomy and gastric drainage in the treatment of pyloric stenosis due to duodenal ulceration.

Cited by 21 publications

References 8 publications

Pyloric stenosis complicating duodenal ulceration

Pyloric stenosis complicating duodenal ulceration

Highly selective vagotomy plus dilatation of the stenosis compared with truncal vagotomy and drainage in the treatment of pyloric stenosis secondary to duodenal ulceration.

Delayed return of gastric emptying after gastroenterostomy

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