Simple suture with or without proximal gastric vagotomy for perforated duodenal ulcer.

To assess the results of proximal gastric vagotomy (PGV) in the definitive treatment of perforated duodenal ulcers, a prospective study was carried out comparing PGV in association with omental patch suture (PGV + S) with the simple omental patch suture procedure (S). The PGV + S series consisted of 38 consecutive patients with perforated duodenal ulcer and the S series consisted of 38 survivors of a similar series of 41 consecutive patients. Surgical mortality was zero in the PGV + S series. The patients were followed up for 1 to 7 years. No cases of dumping or diarrhoea were observed. Thirty-three patients in the PGV + S series (87 per cent) were classified as Visick grade I and only two (5 per cent) as Visick grade IV. In contrast, 11 patients (29 per cent) were Visick grade I and 22 (58 per cent) were Visick grade IV in the S series. Recurrent ulcer was detected endoscopically in 58 per cent of the patients who had been treated with simple suture and in only 5 per cent after suture plus PGV. PGV is a safe operation with a negligible morbidity rate and with a significant rate of effective control of ulcer disease. Depending on the general condition of the patient and on the surgeon's skill, it appears preferable to treat not only the acute perforation but also the ulcer disease by PGV.

Contribution of intraoperative biliary manometry for the diagnosis of bile duct stones.

Sixty patients with cholecystitis and gallstones, with and without biliary duct calculi, were submitted to intraoperative biliary manometry and cholangiography. The patients were subdivided into two groups of 30: Group A, without biliary duct calculi, and Group B, with biliary duct calculi. The pathology had been diagnosed before surgery for 24 patients in group B (B1), and for 6 (B2), diagnosis was made on the basis of intraoperative manometry which showed higher pressure values than those encountered in the main bile ducts of patients without calculi, and of intraoperative cholangiography. Choledocotomy, which was performed on all 6 patients, confirmed the presence of calculi. When three successive sequences of pressure measurements were performed on the common bile duct of patients with biliary duct stones there was an increase in pressure at 10, 15 and 20 s from the first compared to the third sequence. Intraoperative manometry suggested the presence of biliary duct calculi, which was confirmed by intraoperative cholangiography in the 20% of patients in group B for whom calculi had not been previously diagnosed, and decreased unnecessary choledocotomy.