Selective surgery for chronic gastric and duodenal ulcers

Abstract

At the University of Niigata Hospital, selection is attempted from several possible operative procedures for gastric and duodenal ulcers, the independent variables being the patients age, the acidity of gastric juice, the location of ulcer, the degree of gastric tonicity and the complicating lesions of stomach including gastritis. Each procedure and its indication are delineated as follows: 1) Usually, antrectomy or hemigastrectomy with vagotomy is performed for duodenal and gastric ulcers located distal to gastric angle, while a 75% gastrectomy is employed for the patients of old age or with a remarkable atony of the stomach. 2) For gastric ulcers located proximal to gastric angle, a 75% gastrectomy has been performed. 3) For high gastric ulcers, a segmental gastrectomy with pyloroplasty of the Heineke-Mikulicz type and vagotomy is employed. Upon performance of this procedure, the combined vagotomy is not carried out for the cases with the maximal free free acid of less than 30 to 40 cl.u., because the sufficient effective reduction of gastric acidity may be obtained by this procedure (less than 50% gastrectomy) alone. 4) For ulcers of cardiac region, a proximal gastrectomy, about 50% resection of the stomach, is performed. For the cases not associated with the conditions above mentioned, however, a 75% gastric resection is performed. These surgical procedures have been carried out in 659 cases with chronic peptic ulceration of the stomach and duodenum at the University of Niigata Hospital during the past 8 years. Conservative gastrectomies (antrectomy or hemigastrectomy with vagotomy, segmental gastrectomy and proximal gas t rectomy)have been performed in 189 cases or 29% of these 659 cases and gained satisfactory results. The present study has shown the procedures of selective surgery based on Prof. Sakai's new device at the University of Niigata Hospital. Detailed results of this policy may be reported in the future.