Long-term appraisal of the treatment of gastric ulcer in situ by vagotomy and pyloroplasty

Risk factors related to operative mortality and morbidity in patients undergoing emergency gastrectomy

“…In that series, salvage surgery carried a mortality rate of 18 per cent. In general, partial gastrectomy or antrectomy is recommended for bleeding gastric ulcer 14 , although in critically ill patients some surgeons advocate ulcer excision and vagotomy 15 . The basic surgical options for bleeding duodenal ulcer lie either in partial gastrectomy, or vagotomy with oversewing of the ulcer and pyloroplasty 3 .…”

Invited commentary

“…The operative mortality rate (MR) of 1.3% for elective cases in this series is satisfactory. The MR of 7% in patients operated on as emergencies for hemorrhage seems excellent since the MR of PG in such patients is usually greater than 10% and may be as high as 20-40% [4,5]. Hence, in the management of patients with bleeding gastric ulcer, considerations of risk of recurrent ulceration carry relatively little weight.…”

“…Removal of the ulcer itself is simply incidental and probably is not critical in the operation. Therefore, removal of the ulcer is unnecessary, and the operation of pyloroplasty with vagotomy is being performed successfully in numerous centers both in the U.S.A. and abroad [5]. I do not believe that the gastric cancer problem, which is decreasing in incidence, will interfere significantly with the application of vagotomy and pyloroplasty in the treatment of gastric ulcer.…”

Gastric ulcer treated with ulcerectomy, vagotomy, and drainage

“…Truncal or gastric (selective) vagotomy with drainage and ulcerectomy has earned some advocates in recent years [2][3][4][5][6][7][8][9] while, to our knowledge, a series of patients treated by proximal gastric vagotomy and ulcerectomy without drainage has not yet been reported. Gastric (selective) vagotomy reduces acid production, but increases the factor of retention and perhaps also the tendency to pyloric reflux.…”