Vagotomy versus gastric resection, comparative evaluation of relative effectiveness in a controlled series of cases.

Abstract

What surgical procedure should the surgeon advise for the patient with intractable peptic ulcer? Despite an unusually voluminous literature, there is still considerable disagreement on this question among surgeons and clinics throughout the country. The procedures generally advocated are gastroenterostomy, subtotal gastrectomy, and vagotomy—either alone or in combination. Most teaching clinics are in general agreement that gastroenterostomy alone should be reserved principally for the inactive ulcer with obstructive symptoms, in the presence of low acid values, and for occasions when the general condition of the patient makes gastric resection inadvisable. The effectiveness of radical subtotal gastrectomy in controlling the symptoms of intractable ulcer has been amply established by numerous reports with careful and prolonged follow-up studies. 1 The status of this procedure as the surgical treatment of choice has in recent years been challenged by vagotomy, either alone or in combination with gastroenterostomy. Emphasis has been placed upon a low