Recurrence after parietal cell vagotomy for peptic ulcer disease

The value of parietal cell vagotomy as a safe surgical procedure in the treatment of chronic peptic ulcer disease has been seemingly limited by the high recurrence rate usually reported. In this 10 year experience of 405 consecutive parietal cell vagotomy operations, 57 patients with recurrent ulceration were evaluated to try to answer the questions of where and why recurrent ulceration appears and how to treat it. Patients with pyloric or prepyloric ulcer disease had recurrence of disease earlier than did patients with chronic duodenal ulcer disease. Consequently, pyloric or prepyloric ulcer patients had a higher recurrence rate in the early postoperative period than chronic duodenal ulcer patients, but this difference disappeared after the seventh postoperative year. Patients with recurrent chronic duodenal ulcer disease have high postoperative acid secretion levels, indicating incomplete vagotomy as a causative factor. Patients with recurrent pyloric or prepyloric ulcer disease have postoperative acid secretion similar to that of patients without recurrence, suggesting another etiologic factor. Thirty of 57 patients with recurrent ulcer had successful medical treatment. A conservative attitude towards recurrences is justified, particularly when symptoms are few and the postoperative acid secretion tests indicate complete or partial vagotomy. Surgical therapy consisting of truncal vagotomy and pyloroplasty in cases of incomplete vagotomy and antrectomy in cases of complete vagotomy should be reserved for patients with symptoms and a disease course that cannot be controlled by conservative treatment.     

Duodenogastric reflux in peptic ulcer patients following surgical treatment using vagotomy

An analysis of 917 fiber gastroscopies of patients with ulcer disease and chronic gastritis has been made. Results of the complex examination of 140 patients after vagotomy for pyloroduodenal ulcer have been discussed. Gastroduodenal reflux has been found to be a complication of vagotomy. It most frequently follows draining operations on the stomach. The search for new means of surgical correction of duodenogastric reflux is required.     

腹腔镜手术治疗消化性溃疡穿孔对机体炎症反应及免疫功能的影响

目的 探讨腹腔镜手术治疗消化性溃疡穿孔对机体炎症反应及免疫功能的影响,进一步评价腹腔镜穿孔修补术的微创效果.方法 将81例消化性溃疡穿孔患者随机分为腹腔镜手术组（腹腔镜组,37例）和开腹手术组（开腹组,44例）,比较两组患者围手术期外周血降钙素原（PCT）、C反应蛋白（CRP）及T淋巴细胞亚群（CD4、CD8、CD4/CD8比值）变化.结果 术后第1天、第3天两组的PCT、CRP均较术前显著升高（P＜0.05）.术后第5天腹腔镜组的PCT、CRP水平与术前比较,差异无统计学意义（P＞0.05）.术后开腹组的PCT、CRP水平均显著高于腹腔镜组（P＜0.05）.两组术后第1天CD4、CD8水平及CD4/CD8比值均较术前显著下降（P＜0.05）,但术后腹腔镜组CD4、CD8水平及CD4/CD8比例明显高于开腹组（P＜0.05）,且腹腔镜组CD4、CD8水平及CD4/CD8比值均于术后第5天恢复至术前水平（P＞0.05）.结论 与开腹穿孔修补术相比较,腹腔镜穿孔修补术能够有效降低术后炎症反应的程度,且对机体的免疫功能影响更小,具有功能学微创优势.     

Tubular gastrectomy with selective vagotomy in the treatment of peptic ulcer]

The authors generalize the material on the surgical treatment of 151 patients who were operated on for complicated gastroduodenal ulcers by means of an improved method of tubular resection of the stomach with selective vagotomy, subtotal excision of the lesser curvature, and the formation of a ++post-colonic rectangular gastroenteroanastomosis on a short loop with oblique division of the jejunum. The late-term results were studied in follow-up periods of up to 4 years in 110 patients (72.8%) and appraised according to Visik's scale. The results were excellent in 78 (70.9%), good in 25 (22.7%), satisfactory in 6 (5.5%) patients, and poor (recurrence of the disease) in one (0.94) patient.     

Proximal gastric vagotomy for peptic ulcer disease: follow-up of 483 patients for 3 to 14 years

During the years 1972 to 1986, proximal gastric vagotomy was performed in 483 patients for management of duodenal, pyloric, or prepyloric ulcers. In 25 patients a drainage procedure was added because of pyloric stenosis. The operations were performed by 64 surgeons, most of whom were junior residents. After surgery four patients had lesser curve necrosis; one of the patients died. The 14-year cumulative ulcer recurrence rate was similar (about 13%) in patients treated for duodenal and pyloric/prepyloric ulcers. The cumulative recurrence rate was significantly higher in women (17%) than in men (12%). Twenty-three percent of female patients and 16% of male patients were considered Visick grade 4. Moderate dumping occurred in 29% and diarrhea in 7% of the patients. The diarrhea was moderate except in one patient who had disabling diarrhea. Women had more frequent nausea, epigastric fullness after meals, and food intolerance than men. Basal acid output, pentagastrin-stimulated peak acid output, and insulin-stimulated peak acid output were not found to be reliable tests for evaluating the completeness of vagotomy or predicting ulcer recurrence.     

Videothoracoscopic vagotomy in surgical treatment of patients with peptic ulcer of the gastroenteroanastomosis after resection of the stomach

Treatment of 130 patients with peptic ulcer of the gastroenteroanastomosis after resection of the stomach included operation by the method of videothoracoscopic truncal vagotomy (22 patients), left-side videothoracoscopic truncal vagotomy (19 patients), and operation from the right-side access (3 patients). Cicatrization of the ulcer in the postoperative period was obtained in 16 patients. Recurrent peptic ulcer was revealed in 2 patients. There were no lethal outcomes.     

Stomal obstruction after vagotomy in the treatment of obstructing peptic ulcer

A retrospective evaluation of postoperative gastric atony was made on forty patients operated on for obstructing duodenal ulcer. The incidence of this complication was only 3.1 per cent (one patient in thirty-two) in those undergoing antrectomy and vagectomy, and did not occur in eight treated by subtotal gastrectomy. In light of the pathophysiology of postoperative gastric atony in patients with obstruction and in view of the undesirable side effects of gastrectomy, it is believed that antrectomy with vagotomy is the procedure of choice for this condition.