[Treatment of perforated duodenal ulcers]. / Traitement des ulcères duodénaux perforés.

Final surgical treatment of perforated duodenal ulcer is not admitted by all authors. The aim of this study is to evaluate final treatment of perforated duodenal ulcer among 110 patients. 74.5% were aged less than 41 years. 107 patients underwent surgery. Treatment was based on: truncal vagotomy with pyloroplasty (99 cases), truncal vagotomy with closure of duodenal perforation and gastroentero-anastomosis (5 cases), truncal vagotomy with antrectomy (1 case) and simple closure of the duodenal perforation (2 cases). Mortality of truncal vagotomy with pyloroplasty was about 1%. According to the visick evaluation, clinical results were good in 95.3% cases without recurrent ulcer with a mean follow up of 4 years. According to our results truncal vagotomy with pyloroplasty seems to be a safe procedure in the management of perforated duodenal ulcer and more over gives good long-term results in control of peptic disease.

Proximal gastric vagotomy. Comparison between open and laparoscopic methods in the canine model.

OBJECTIVE: The authors compared open and laparoscopic proximal gastric vagotomies for efficacy of acid reduction and preservation of gastric emptying. SUMMARY BACKGROUND DATA: Laparoscopic methods have been used to perform vagotomy in patients with duodenal ulcer; however, no direct comparisons are available of laparoscopic and open surgical procedures regarding acid reduction and gastric emptying. METHODS: Thirty-one consecutive dogs were randomized to open proximal gastric vagotomy (OPGV; n = 11), laparoscopic anterior seromyotomy and posterior truncal vagotomy (ASPTV; n = 10), or laparoscopic proximal gastric vagotomy (LPGV; n = 10). Intraoperative endoscopic Congo red testing assured complete vagotomy. Basal acid output (BAO) and maximal acid output (MAO) during pentagastrin and insulin-induced hypoglycemia were measured with marker dilution techniques, and gastric emptying was assessed with radionuclide-labelled solid and liquid markers before and 5 weeks after operation. RESULTS: Operative time (mean +/- standard error of the mean) for OPGV was shorter compared with ASPTV and LPGV (86 +/- 7 minutes vs. 124 +/- 7 minutes and 115 +/- 7 minutes; p < 0.002). Postoperative BAO did not decrease in any group. Open proximal gastric vagotomy and LPGV, but not ASPTV, decreased MAO (p < 0.05); (after pentagastrin, OPGV from 26.4 +/- 1.7 mEq/hour to 11.3 +/- 0.1 mEq/hour, LPGV from 21.4 +/- 1.0 mEq/hour to 6.4 +/- 0.5 mEq/hour; after insulin-induced hypoglycemia, OPGV from 9.9 +/- 0.5 mEq/hour to 2.2 +/- 0.3 mEq/hour, LPGV from 7.9 +/- 0.5 mEq/hour to 1.9 +/- 0.4 mEq/hour). Gastric emptying of liquids and solids, as quantitated by the time for one half of the marker to empty (T 1/2) and the shape of the emptying curve, were similar before and after all three surgical procedures. CONCLUSIONS: Laparoscopic proximal gastric vagotomy was comparable to OPGV in decreasing stimulated gastric acid production without significantly altering gastric emptying. Anterior seromyotomy and posterior truncal vagotomy was less effective in decreasing MAO and required more operative time. Laparoscopic proximal gastric vagotomy has the potential to become accepted therapy for patients with duodenal ulcer managed presently with OPGV.

Vagotomy and antrectomy revisited.

A retrospective review of 185 patients who underwent truncal vagotomy and antrectomy for duodenal ulcer disease was carried out to determine the mortality and morbidity of the procedure. There were no deaths within 30 days of operation and only one patient died while in the hospital (0.54%). Twenty-one patients (11.4%) suffered early morbidity, 3 of them requiring a second operation. Follow-up was obtained in 83 patients and averaged 13.5 years. According to Visick's classification 75 patients (90.4%) were in class I or II; 5 patients (6%) were in class III and 3 patients (3.6%) in class IV. A recurrent ulcer developed in 2 of the 83 patients. In contrast, after highly selective vagotomy, the literature supports an unacceptable incidence of recurrent ulcer. Therefore, we must not prematurely cast aside vagotomy and antrectomy; it still remains a safe and acceptable procedure for duodenal ulcer disease.

[Late results of gastrectomy and truncal vagotomy in duodenal ulcer]. / Otdalennye rezu'ltaty rezektsii zheludka i stvolovoi vagotomii pri iazve dvenadtsatiperstnoi kishki.

In equal groups of patients with duodenal ulcers truncal vagotomy with draining operations were performed in 98 patients, gastric resection--in 196 patients. The observations lasted from 2 to 7 years. Immediate lethal outcomes did not take place after vagotomy. Six patients died after gastric resection (3.05%). Postoperative complications were observed in 8% and 22.7% correspondingly. In remote periods after vagotomy 75% of the patients were referred to the I and II group (by the Wisik scale), 12% of patients--to the III group, 12%--to the IV group, after gastric resection--70%, 20% and 10% correspondingly.