Accumulated experience with vagotomy and pyloroplasty for surgical control of hemorrhagic gastritis

Abstract

s INCE 1964 an increasing number of patients with severe hemorrhage from gastritis have been treated with vagotomy and pyloroplasty [l--3]. The experience seems to have been fairly uniform and generally successful. This is indeed fortunate because the alternate surgical methods previously employed in the management of severe hemorrhagic gastritis have a higher immediate mortality and significant late side effects which may be severe. Earlier reports have indicated generally poorer results when subtotal resection alone is employed to control hemorrhagic gastritis [4]. Total gastrectomy would of course control bleeding, but the patient pays a tremendous price at significant risk for control of a lesion that may never again threaten his life. Since the earlier suggestions of pyloroplasty and vagotomy were based on only ten patients, there was uncertainty as to the extent that the procedure could be applied, the incidence of early and late rebleeding, and the effect of subsequent alcoholic bouts as well as numerous other questions. The answers to these questions were made more critical with subsequent reports of significant rebleeding in the early postoperative course [2,3,5]. Including the present expanded series and those of Ferguson and Clarke [Z], Nagel et al. 131, and Bartlett and Ottinger [5], there are now fifty-four recently reported cases treated primarily by vagotomy and pyloroplasty. This accumulated experience forms the basis of the present report and allows more accurate evaluation than previously. The critical question is whether this most simple procedure affords reliable control of bleeding or whether some form of resection is necessary in addition to vagotomy for sufficient assurance that the patient will not bleed to death or be subject to rebleeding. The report of Bartlett and Ottinger ]5] citing excellent control of bleeding by vagotomy and antrectomy in seven patients requiring emergency surgery for gastritis brings this problem into sharper focus.