Late follow-up of highly selective vagotomy with excision of the ulcer compared with Billroth I gastrectomy for treatment of benign gastric ulcer

Reid, D.A. Campbell; Duthie, H. L.; Bransom, C. J.; Johnson, A. G.

doi:10.1002/bjs.1800691016

Cited by 26 publications

(10 citation statements)

References 15 publications

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“…Where there is either a long history of ulceration or simple closure is impossible, either because of the size or the situation of the ulcer, partial gastrectomy is the treatment of choice (Jordan et al, 1963;Skanstein & Hoisater, 1976;Playforth & MacMahon, 1978). Whilst highly selective vagotomy may be as effective as partial gastrectomy in the elective treatment of chronic gastric ulcer (Reid et al, 1982;Dewar et al, 1983), it is technically difficult in the presence of a perforated gastric ulcer. The average duration of symptoms in our patients undergoing partial gastrectomy was 5 y.…”

Section: Discussionmentioning

confidence: 99%

Perforated gastric ulcer

Wilson-MacDonald

Mortensen

Williamson

1985

Postgraduate Medical Journal

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Summary:Thirty-four patients presenting with gastric perforation over a ten year period were studied, retrospectively. Five patients (14%) died either as a result of delay in treatment or wrong diagnosis. In addition, 2 patients (6%) died from postoperatve complcations Twelve patients (38%) were on potentially olcerogenic drugs Patients who had either simple dosure of ulcers (a = 17) or partial gasectomy (n =6) had few symptoms at follow-up, but patients who underwent bt al vagotomy and pyloroplasty (n =7) had poorer results. There were 2 recurnt ulcers following simple closure.

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Section: Discussionmentioning

confidence: 99%

Perforated gastric ulcer

Wilson-MacDonald

Mortensen

Williamson

1985

Postgraduate Medical Journal

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“…In these prospective, randomized trials there was no significant difference between PGV with ulcer excision for gastric ulcer type I or Billroth I partial gastrectomy. In the study of Reid et al [14], there was a significant difference comparing the overall Visick gradings between the 2 groups in favor of PGV with ulcer excision when excluding patients with recurrent ulcer. The authors conclude that PGV with ulcer excision gives a better symptomatic result in the long-term than Billroth I partial gastrectomy for type I gastric ulcer and should be considered as a genuine alternative in the younger patient, if the ulcer can be completely excised without damaging the antral innervation.…”

Section: Comments and Conclusionmentioning

confidence: 90%

“…The preferred operative treatment of recurrent peptic ulcer following PGV is partial gastric resection [4,13,14], although the best results have been reported by Kennedy and Green [27] with antrectomy and revagotomy. There was no mortality in 85 patients with recurrent ulcer following PGV for duodenal ulcer and there was only 1 second recurrence.…”

Section: Type Imentioning

confidence: 99%

Recurrence after proximal gastric vagotomy for gastric, pyloric, and prepyloric ulcers

Heberer

Teichmann

1987

World j. surg.

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Results after proximal gastric vagotomy (PGV) with ulcer excision for gastric ulcer type I (according to Johnson) show recurrence rates similar to those for duodenal ulcer. In the European Multicenter Trial with 71 patients, symptomatic recurrence was 7.9% at 5 years and the total recurrence (including asymptomatic recurrences) was 17.5%. Recurrent ulcers are mainly gastric ulcers. Treatment of recurrence is, initially, always conservative with antacids or H2-receptor blockers. From 19 patients with recurrent ulcer after PGV with ulcer excision for gastric ulcer type I reported from 3 prospective trials, 12 were managed conservatively. The operative procedure of choice for recurrence was partial gastric resection with a Billroth I or Billroth II reconstruction. Favorable results for this type of gastric ulcer after PGV may be explained by maintenance of gastric continence for solids, reduction of duodenogastric reflux and of postoperative gastritis. Preoperatively and intraoperatively, malignancy has to be excluded by multiple biopsies and frozen sections. Combined gastric and duodenal ulcers (gastric ulcer type II) may also he treated by PGV in controlled trials so that more data will be available for that rare type of ulcer. Recurrence rates after PGV for pyloric and prepyioric ulcers (gastric ulcer type III) are significantly higher than those for gastric ulcer type I or duodenal ulcers. After 5 years, recurrence rates of 16.4-35% are reported. This may be due to gastric retention, which is a common feature in patients with prepyloric ulcers. In fact, selective gastric vagotomy and drainage or vagotomy and antrectomy give significantly better results. The operation rate for recurrent ulcers after pyloric and prepyloric ulcers following PGV is about 25% because of pyloric stenosis. It is concluded that PGV and ulcer excision seem to be suitable for gastric ulcer type I and probably for type H. Pyloric and prepyloric ulcers should no longer be treated by PGV alone because of high recurrence rates. A drainage procedure should be added. In general, the operation should be performed by experienced surgeons since recurrence rates depend on the number of surgeons involved in cliulcal trials.It is well established that the only significant postoperative morbidity following proximal gastric vagotomy without pyloroplasty (PGV) for gastroduodenal ulcer disease is ulcer recurrence [1][2][3][4]. Virtually 5 years after PGV, the Visick grade pattern is almost identical with that of blood donors serving as healthy controls [5]. PGV without a drainage procedure was first introduced for treatment of gastric ulcers by Johnston et al. [6]. To evaluate the results of PGV for benign gastric ulcer disease, it is absolutely mandatory to define the type of the

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“…Although we could find no report in the literature comparing gastrectomy with vagotomy for HGU, there are studies comparing these 2 when used for more distal ulcers [28,30,43]. If one may be allowed to extrapolate these results to the situation under discussion, the following conclusions may be drawn: The mortality and immediate postoperative morbidity of gastrectomy is higher than that of vagotomy [30,44] and this becomes more apparent in the emergency situation [5,16].…”

Section: Total Gastrectomymentioning

confidence: 99%

“…The recurrent ulcer rates are higher after vagotomy than after gastrectomy [28,30,44]. The incidence of cases that can be interpreted as missed carcinomas appears to be higher after vagotomy than after gastrectomy [28,30,34,43]. If vagotomy is to be practiced for gastric ulcer, it seems to be wise to excise the ulcer in order to decrease recurrence rates and the incidence of missed cancer [2,17,26,28,32,34,43].…”

Section: Total Gastrectomymentioning

confidence: 99%

High gastric ulcer

1987

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Fifty-six patients with high gastric ulcers were studied retrospectively. There were 38 women and 18 men. The mean age was 66 years. Findings were: 25% had ulcer histories of more than 5 years; 45% had illnesses in other systems making them poor operative risks; 34% were taking ulcerogenic drugs, and 36 % were on antiulcer treatment prior to surgery; 43% presented with severe bleeding, 16% with perforation, and 2 patients had simultaneous bleeding and perforation; 38% had deeply penetrating ulcers and many ulcers were very large; 7 patients had ulcers in hiatus hernias. Sixty-three percent of the procedures were emergencies. Half of the operations were nonresective, with or without vagotomy. The other half were gastric resections of various types. The overall mortality rate was 18%, but the mortality rate was 24% for emergency procedures and 9% for elective ones. The highest mortality rate, 45%, occurred after emergency resective procedures. Vagotomy did not increase postoperative mortality when added to a nonresective procedure. Beside the 10 patients who died, 6 others developed severe postoperative complications, usually respiratory failure or suture line leakage. Follow-up of between 6 months and 12 years (average 3 years) was possible in 55% of the patients. Two developed recurrent ulcers and 2 had overlooked gastric carcinomas. An approach of management for high gastric ulcer is outlined recommending a Pauchet operation for good-risk patients, and vagotomy and drainage for old and frail patients. Medical treatment should be pursued as long as possible to avoid an often hazardous operation.

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Late follow-up of highly selective vagotomy with excision of the ulcer compared with Billroth I gastrectomy for treatment of benign gastric ulcer

Cited by 26 publications

References 15 publications

Perforated gastric ulcer

Perforated gastric ulcer

Recurrence after proximal gastric vagotomy for gastric, pyloric, and prepyloric ulcers

High gastric ulcer

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