Procedures of value for the prevention and cure of dumping after vagotomy and pyloroplasty

Abstract

There is no question that vagotomy with pyloroplasty is a satisfactory operation for the treatment of peptic ulcer disease of both the stomach and duodenum. The poor results are due to incomplete vagotomy and the variations in the size of the pyloric canal after Heineke-Mikulicz pyloroplasty. Recurrent ulceration may occur if the vagotomy is incomplete, and dumping may occur if the pyloroplasty results in a large pyloric canal. A large pyloric pouch with a lumen admitting two and a half to three fingers was found at operation in four patients with severe manifestations of the dumping syndrome. Their symptoms were lessened after reconstruction of the pylorus so that the lumen admitted only one finger. It is our belief that anterior hemipylorectomy is a simple and safe operation and produces little or no deformity of the pylorus. It has a built-in limitation as to the size of the lumen. The postcibal symptoms encountered in our rather limited experience (fifty-one cases) with a short follow-up period, were mild and transient. They were, however, in keeping with the findings of Beattie, Holt and Lythgoe, and others [11,12]. In conclusion, we believe that the use of an anterior hemipylorectomy, instead of Heineke-Mikulicz or other types of pyloroplasty, will result in a decreased incidence of dumping after vagotomy. We also believe that in patients with severe dumping syndrome after vagotomy and pyloroplasty, reconstruction of the pylorus should be performed before more formidable procedures are attempted.