The relationship between the severity of duodenal ulceration and the results of bilateral vagotomy and gastrojejunostomy

Feggetter, George Y.; Pringle, R

doi:10.1002/bjs.1800520914

Cited by 13 publications

(10 citation statements)

References 8 publications

(9 reference statements)

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“…All the patients were well satisfied with the operation and there was only one who was less than entirely pleased, this on account of monthly episodes of mild diarrhoea. In this assessment we are supported by the longer review of a larger series of patients reported by Feggetter and Pringle (1965) already quoted above.…”

Section: Discussionsupporting

confidence: 71%

“…Feggetter and Pringle (1965) could find no difference in long-term follow-up between patients operated upon because of failed medical treatment and those whose indications for surgery were the serious complications of duodenal ulceration, i.e., perforation, haemorrhage and stenosis, who had been treated by vagotomy and gastro-jejunostomy. Of 41 patients with stenosis thus treated who were studied 10 to 14 years later, 28 had excellent and six had good results.…”

Section: Discussionmentioning

confidence: 84%

See 1 more Smart Citation

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

Ellis¹,

Starer²,

Venables³

et al. 1966

Gut

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 84%

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

Ellis¹,

Starer²,

Venables³

et al. 1966

Gut

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“…Haemoglobin levels below 90% have been reported in 14% of 40 patients eight years after vagotomy and gastrojejunostomy (Burge and Pick, 1958), and in approximately 10% of 209 patients studied 10 to 14 years after operation by Feggetter and Pringle (1963). In neither study was consideration given to possible sex differences or to haemoglobin values before operation.…”

Section: Rangementioning

confidence: 99%

Aspects of Nutrition after Vagotomy and Gastrojejunostomy

Cox¹,

Bond²,

Podmore³

et al. 1964

BMJ

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The choice of operation in the surgical treatment of chronic duodenal ulcer remains a controversial subject. Partial gastrectomy is now performed less frequently, as surgeons are increasingly attracted to the advantages of vagotomy, which effects a substantial reduction of gastric-acid secretion in most cases. Recurrent ulceration appears to be more common after vagotomy than after partial gastrectomy, but this disadvantage of vagotomy is balanced and possibly outweighed by the higher post-operative mortality rate after partial gastrectomy. The major criticism of partial gastrectomy is that it leads to an unacceptably high incidence of late complications, which include alimentary symptoms such as postprandial abdominal discomfort, dumping, and vomiting, and also impaired nutrition manifested by loss of weight, anaemia, and more rarely osteomalacia. Although agreement is not complete, many publications support the contention that untoward alimentary symptoms are comparatively infrequent after vagotomy. However, there is remarkably little information in the literature to substantiate the view that impaired nutrition is rare after vagotomy. In order to provide data relevant to this latter problem, this paper reports the results of a study of patients after vagotomy and gastrojejunostomy for chronic duodenal ulcer.Vagotomy has been extensively used in Sheffield since 1958, and the interval between operation and the present review varied between 37 and 57 months in the patients studied; we have therefore considered the results as representing a post-operative investigation at approximately four years. A gastric drainage procedure must be performed simultaneously with vagotomy, which by itself causes a high proportion of symptoms due to delayed gastric emptying. Gastrojejunostomy was combined with vagotomy in the present series, and the patients having pyloroplasty in the period under consideration have not been included as they were too few to merit detailed investigation. The study was designed to give as much information as possible without requiring more co-operation than could reasonably be expected from our patients. The tests were therefore restricted to peripheral blood examination, estimation of serum-iron and serum-vitamin-B12 levels, and measurement of vitamin-B1, absorption and faecal fat excretion. In addition, the patients were asked about alimentary symptoms and weight changes before and after operation. Insulin tests to confirm completeness of vagotomy were not performed in all patients, but a recent study from this department suggests that vagal-nerve section was achieved in approximately 90% of patients (Ross and Kay, 1964 Clinical MaterialFrom a consecutive series of 120 patients with chronic duodenal ulcer treated by vagotomy and posterior gastrojejunostomy approximately four years previously, 25 were excluded because of death (5), reoperation (7), failure to attend (7), and distance from Sheffield (6). The 95 patients remaining for detailed investigation were 75 males and 20 females. Some were un...

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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: 87%

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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The relationship between the severity of duodenal ulceration and the results of bilateral vagotomy and gastrojejunostomy

Cited by 13 publications

References 8 publications

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

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

Aspects of Nutrition after Vagotomy and Gastrojejunostomy

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

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