Abstract
Summary The aim in the surgical treatment of duodenalulcer and its complications is to obtain permanent Healing with a minimum of disturbance of the function of digestion. It is our opinion, based on a large experience over a period of six years, that vagotomy and pyloroplasty accomplish this end more effectively than any of the other surgical procedures currently in use. Failure to heal the ulcer by vagotomy is almost invariably due to incomplete interruption of the nerves. Complete vagotomy calls for good exposure and a familiarity with the pattern of the vagus nerves in the lower part of the mediastinum. Special emphasis is given to the technic ofpyloroplasty. The commonly used technic of employing two or more rows of sutures to close the pyloroplasty wound causes an infolding of tissues which may interfere with satisfactory emptying of the stomach and thus defeat the purpose of the pyloroplasty. This difficulty is avoided by using a single row of sutures. There has been no evidence of leakage in the more than 500 pyloroplasties performed in our clinic with the one-row suture technic. An important consideration in the successful use of pyloroplasty is the -recognition of its contraindications. It is unsatisfactory for cases in which the pyloroduodenal segment is constricted or distorted by inflammatory edema or excessive scarring. It is also unsuited for cases in which the stomach is dilated and low-hanging. Gastrojejunostomy or limited gastric resection should be used in these situations. An evaluation of 200 patients with two tosix years of follow-up study shows that 89.5 per cent have good results. Five per cent are failures because of definite or suspected evidence of recurrence. The remaining 5.5-per cent are designated as poor results for reasons of post-operative sequelae or manifestations of a disturbed emotional state. The surgical mortality in our entire group ofmore than 500 operations of vagotomy and pyloroplasty is less than 0.5 per cent.
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