[The treatment of upper digestive hemorrhages due to duodenal ulcer by direct hemostasis and vagotomy of the oxyntic cells]. / Tratamiento de las hemorragias digestivas altas por úlcera duodenal mediante hemostasia directa y vagotomía de células oxínticas.

Management of upper gastrointestinal haemorrhage continues to present a challenge in surgical judgment. To evaluate the incidence of rebleeding, ulcer recurrence, mortality and morbidity derived from the surgical technique, we made a prospective study in patients with active bleeding duodenal ulcer (endoscopy diagnosis in all cases), excluding patients with serious intercurrent diseases NSAIDS intake drugs and over seventy years of age. In 49 patients, oxyntic cell vagotomy with undersewing bleeding ulcer were performed in the period 1972-1984. Periodic controls were established, included clinical, radiographic and gastroduodenoscopic evaluation. Five years after operation 35 patients could be evaluated. In these cases, mortality was nil. No early rebleeding was observed. Long term endoscopic results showed only 2.85% of relapses. The results obtained in this study show that oxyntic cell vagotomy with undersewing bleeding ulcer may be a technique of choice in the treatment of bleeding duodenal ulcers and it should be more extensively used in emergency services.

[The long-term results of the surgical treatment of gastroesophageal reflux by the pexis of the round ligament]. / Resultados a largo plazo del tratamiento quirúrgico del reflujo gastroesofágico mediante pexia con el ligamento redondo.

A prospective study was began in 1973 of the treatment of pathological gastroesophageal reflux and its complications using the round ligament (ligamentum teres) for gastropexy. A total of 116 patients were operated until 1987 and 100 are evaluated (77% over five years postoperation). Diagnostic procedures and surgical indications are evaluated, periodic controls were established including clinical, radiographic and gastroduodenoscopic evaluation. The results obtained in this group were satisfactory following "Frenchay Hospital" of Bristol criteria (94% favorable results) with an estimated endoscopic recurrence of 5%. The mortality was nil and complications were minimal. We conclude that this procedure should be considered among the surgical options for resolving the pathological gastroesophageal reflux and its complications, in view of the minimal morbidity, absence of mortality and excellent results obtained.

[Double cancer of the gallbladder]. / Cáncer doble de vesícula biliar.

A patient is presented with two independent gallbladder carcinomas, squamous and adenocarcinoma which appeared to be independent. The pathogenesis, symptomatology, diagnosis, therapy and prognosis are discussed and a review of the literature is offered.

[Risk of carcinoma of the stomach after vagotomy]. / Riesgo de carcinoma gástrico tras vagotomía.

To evaluate the influence of vagotomy in the development of gastric carcinoma, we conducted a prospective, controlled study of 183 patients diagnosed of gastric or duodenal peptic ulcer resistant to medical treatment; all cases had been treated by oxyntic cell vagotomy, without drainage, in the Departamento de Cirugía del Hospital Universitario Virgen del Rocío, Sevilla. Once a year all patients were clinically, radiologically and endoscopically evaluated. In 149 patients followed during 14 years, we did not find any case of carcinoma or premalignant lesions. Therefore, our experience does not suggest that, in the absence of drainage, vagotomy constitutes a contributory factor in the development of gastric carcinoma.

[Therapy of ulcer recurrence after vagotomy of oxyntic cells with sucralfate]. / Tratamiento de las recidivas ulcerosas tras vagotomía de células oxínticas (VCO) con sucralfato.

Several methods of treatment have been proposed for the recurrences of peptic ulcers after surgery; they consist of different forms of re-operation, medical treatment (H2 receptors antagonists, cytoprotectors, etc...). First, it is convenient to establish the cause of the recurrence and to rule out the presence of hypersecretory conditions, as inadequate previous surgery or a non identified gastrinoma. Because of the enhancing effect of the cytoprotective drugs on the defense mechanisms of the mucosal barrier, the group of patients with limited acid secretion and recurrent ulcer may obtain benefit from these drugs. To demonstrate this hypothesis we realized a prospective study on 30 patients with recurrent gastro-duodenal peptic ulcer after parietal cell vagotomy without drainage; all the patients were treated with sucralfate during two months. The results can be considered favourable, with endoscopic healing of the ulcer in more than 50% of the cases at the end of the treatment.

[Vagotomy of the oxyntic cells associated with simple closing as surgical treatment of perforated duodenal ulcer. A comparative study with simple closing alone]. / La vagotomía de células oxínticas asociada al cierre simple como tratamiento quirúrgico del ulcus duodenal perforado. Estudio comparativo con el cierre simple sólo.

To evaluate the incidence of ulcer recurrence, mortality and morbidity derived from the surgical technique, we made a prospective and randomized study in patients with perforated duodenal peptic ulcer, within 10 hours after the acute episode and without intercurrent serious diseases. In a total of 180 patients, oxyntic cell vagotomy (VCO) with simple closure or simple closure alone were performed alternatively in the period from 1971 to 1977. Periodic controls were established that included clinical, radiographic and gastroduodenoscopic evaluation. Twelve years after operation, 115 of the patients could be evaluated. Recurrence was defined as endoscopic or surgical evidence of the ulcerous lesion. The endoscopic results after 12 years showed 1.56% of relapses in the group that underwent oxyntic cell vagotomy with simple closure, and 54.9% in the group that only had simple closure (p less than 0.0005). There were also significant differences in the clinical and radiographic controls, and in the degree of comfort achieved with the technique. Mortality was null in both groups and there were no differences between the two techniques as regards morbidity. The results obtained in this study show that oxyntic cell vagotomy with simple closure of the perforation may be the technique of choice in the treatment of perforated duodenal peptic ulcer, which is why we think is should be more extensively used in emergency services.

[Treatment of congenital aganglionic megacolon in adults]. / Tratamiento del megacolon congénito agangliónico en el adulto.

The authors present 5 cases of congenital aganglionar megacolon in patients over 12 years of age. They were diagnosed and treated in the Digestive System Service and Surgery Department of the "Virgen del Rocío" University Hospital of Seville (Spain). After describing the infrequent incidence of this pathology outside early childhood, the different procedures proposed for its diagnosis are described. Once clinical suspicion of megacolon was established, a careful clinical history with special reference to bowel habit from birth was made, as well as a barium enema, anorectal manometry and rectal endoscopy and biopsy for histological and histochemical studies. Once diagnosed, all patients underwent surgery consisting in excision of the aganglionar colorectal segment, retrorectal lowering of the healthy colon and exteriorization through the fibers of the internal anal sphincter. A side-to-side transanal anastomosis between the healthy colon and diseased rectum (Duhamel II) was fashioned. All the patients had a satisfactory evolution with little immediate morbidity. Five to ten years after performing the operations, the patients remained asymptomatic, without bowel habit disturbances and showed an adequate development.

[Carcinoma of the gastric stump after surgery of gastroduodenal ulcer]. / Carcinoma del muñón gástrico tras cirugía por ulcus gastroduodenal.

Thirty-two cases are presented of carcinoma of the gastric stump after surgery for gastroduodenal ulcer disease, duodenal in 19 patients (59.38%) and gastric in 13 (40.65%). All underwent gastric resection, with Billroth I type reconstruction in 5 cases (15.62%) and Billroth II in 27 (84.36%). The patients generally had very advanced carcinoma at the time of diagnosis and the studies made, barium contrast and endoscopy, were always positive. The operability rate was 84.26% and the rate of curative resectability was 28.12%, this group of patients attaining the longest survival. An evaluation was made of the possible mechanisms implicated in the pathogenesis of this type of carcinoma, type of operation performed, location of the peptic lesion, type of reconstruction, etc. A follow-up protocol was established for the patients who underwent resection, the degree of risk being evaluated in relation to the postoperative period. Finally, to prevent the potentially neoplastic stage of the gastric stump, we present surgical procedures for the treatment of the ulcerative disease which have not been demonstrated to increase the long-term risk of gastric carcinoma.