Von Haberer-Finney gastrectomy revisited

Von Haberer and Finney independently introduced end-to-side gastroduodenostomy for gastrointestinal reconstruction. Clinical appraisal of this procedure with hemigastrectomy is the basis of this report. From 1967 to 1982, 113 duodenal ulcer patients underwent the operation. Indications were intractability in 58 patients, hemorrhage in 36, perforation in two, and obstruction in 17. Truncal vagotomy was performed on all patients except in five with intractability, 19 with hemorrhage, two with perforation, and 17 with obstruction. There were three postoperative deaths (2.7%). Nine patients were lost to follow-up, seven of whom were operated upon 5 or more years previously. Thus far, there has been no clinical evidence of recurrent ulcers or of dumping. Five patients, all chronic alcoholics, were below normal weight. The Von Haberer-Finney gastrectomy has certain distinct advantages: 1) direct inspection of the interior of the descending duodenum is possible during duodenotomy; 2) anatomic continuity of the gastrointestinal tract is established; 3) duodenal stump perforation does not occur because the duodenum can be decompressed via a nasogastric tube passed through the anastomosis; 4) afferent loop syndrome cannot occur; and 5) iron deficiency anemia is less likely because the duodenum is not bypassed.     

Laparoscopic-assisted vagotomy and distal gastrectomy

This is a report of the techniques used on and outcome for three patients who underwent laparoscopic-assisted vagotomy and distal gastrectomy for complicated peptic ulcer diseaseThe first patient had a Billroth I anastomosis in 2 h 42 min with an estimated blood loss of 200 ml. Oral fluids were started on day 3 and the diet progressed to a soft food by day 5. The patient was discharged 11 days after his gastrectomy following a transurethal prostatic resection on day 6.The second patient had a Billroth II anastomosis. The operation was completed in 4 h 40 min with an estimated blood loss of 350 ml. Oral fluids were commenced on the 1st postoperative day and the patient was tolerating a soft diet by day 4. The patient was discharged 5 days after his gastrectomy.The third patient had a Billroth I anastomosis with an estimated blood loss of less than 150 ml. The surgery took 2 h 35 min; the patient was tolerating oral fluids on the first postoperative day and was discharged on the 4th postoperative day on soft diet.Laparoscopic-assisted vagotomy and gastrectomy has the advantages of a minimal-access procedure without the risks of an intracorporeal anastomosis.     

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.     

Pancreatic endocrine function after total gastrectomy and truncal vagotomy

Oral and intravenous glucose tolerance tests were performed in four groups: (1) preoperative patients, (2) patients with interposition reconstruction after total gastrectomy, (3) patients with Roux-Y reconstruction after total gastrectomy, and (4) patients with intrathoracic replacement after esophagectomy. We obtained the following results: (1) Hyperglucagonemia in response to orally administered glucose occurred after truncal vagotomy and occurred in the presence and absence of gastric tissue. (2) compared wtih the preoperative study, all postoperative groups demonstrated glucose intolerance. (3) The glucose intolerance was due to increased glucagon, insulinopenia, and possibly nutritional factors. (4) The insulin response to intravenous glucose suggests an impairment in the first phase of insulin secretion in the surgically treated group, demonstrating a role for the vagus in insulin secretion. (5) The glucose tolerance curve shows that the interposition operation is superior the the Roux-Y operation.     

Clinical experience with biliopancreatic bypass and gastrectomy or selective vagotomy for morbid obesity

In 1980 Scopinaro described biliopancreatic bypass for the treatment of obesity. This procedure was aimed at selective malabsorption. The authors used Scopinaro's procedure in 33 patients, but in 17 they modified it by doing selective vagotomy with closure of the duodenum in continuity instead of a subtotal gastrectomy. Eighteen months after the operation, 88% of the patients had what the authors considered was a good to excellent result, that is a loss of more than 25% of the patient's initial weight. Morbidity of many kinds was encountered but most was self-limiting or easily corrected by medical means. From their experience the authors conclude that biliopancreatic bypass as a procedure for the treatment of morbid obesity should continue to be performed and evaluated.     

Late results of gastrectomy and truncal vagotomy in duodenal ulcer

In equal groups of patients with duodenal ulcers truncal vagotomy with draining operations were performed in 98 patients, gastric resection--in 196 patients. The observations lasted from 2 to 7 years. Immediate lethal outcomes did not take place after vagotomy. Six patients died after gastric resection (3.05%). Postoperative complications were observed in 8% and 22.7% correspondingly. In remote periods after vagotomy 75% of the patients were referred to the I and II group (by the Wisik scale), 12% of patients--to the III group, 12%--to the IV group, after gastric resection--70%, 20% and 10% correspondingly.     

Effects of vagotomy and gastrectomy on pancreatic glucagon release.

The effects of gastrectomy and vagotomy on pancreatic glucagon release were investigated clinically. The study included 20 men and eight women, who ranged in age from 28 to 69 years, and who were divided into the following four groups: 1) patients with gastroduodenal ulcers treated with partial gastrectomy, by the Billroth I method, whose hepatic branch was preserved (n = 7). 2) Patients with gastroduodenal ulcers treated with partial gastrectomy, by the Billroth II method, whose hepatic branch was preserved (n = 7). 3) Patients with gastric carcinoma treated with subtotal gastrectomy, by the Billroth I method. In these cases lymphadenectomy required section of the hepatic branch (n = 7). 4) Patients with gastric carcinoma treated with subtotal gastrectomy, by the Billroth II method. In these cases lymphadenectomy required section of the hepatic branch (n = 7). Oral glucose tolerance tests were performed in 10 patients, before operation, and in 28 gastrectomized and vagotomized patients. In the preoperative patients and in the first group, oral glucose (50g) suppressed pancreatic glucagon release, but in the other groups pancreatic glucagon levels were markedly increased.     

Modified segmental gastrectomy combined with vagotomy for a gastric ulcer near the gastro-esophageal junction

To avoid proximal gastrectomy which destroys the gastroesophageal closing mechanism, modified segmental gastrectomy with vagotomy was performed on 3 patients with gastric ulcers located in the stomach near the gastro-esophageal junction. These were all patients in whom a proximal gastrectomy would usually have been performed. The proximal line of resection did not encroach upon the mucosal rosette being within 1 cm of it following the margin of the ulcer. In each patient, the modified segmental resection of the upper stomach consisted of the surgical removal of a continuous strip of tissue including the ulcer and ulcer-bearing area along the wall followed by an end to end gastro-gastrostomy. In the 10 years following surgery, there have been no signs of reflux esophagitis, stricture, or recurrent ulcers in any of the 3 patients. This modified segmental gastrectomy with vagotomy is therefore recommended for gastric ulcers located near the gastro-esophageal junction.     

Modified segmental gastrectomy combined with vagotomy for a gastric ulcer near the gastro-esophageal junction

To avoid proximal gastrectomy which destroys the gastroesophageal closing mechanism, modified segmental gastrectomy with vagotomy was performed on 3 patients with gastric ulcers located in the stomach near the gastro-esophageal junction. These were all patients in whom a proximal gastrectomy would usually have been performed. The proximal line of resection did not encroach upon the mucosal rosette being within 1 cm of it following the margin of the ulcer. In each patient, the modified segmental resection of the upper stomach consisted of the surgical removal of a continuous strip of tissue including the ulcer and ulcer-bearing area along the wall followed by an end to end gastro-gastrostomy. In the 10 years following surgery, there have been no signs of reflux esophagitis, stricture, or recurrent ulcers in any of the 3 patients. This modified segmental gastrectomy with vagotomy is therefore recommended for gastric ulcers located near the gastro-esophageal junction.     

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自 18 8 1年Billroth首创胃大部切除治疗消化性溃疡以来已有 10 0多年的历史 ,随着外科技术的发展和手术技术的不断改进 ,到 2 0世纪 4 0年代 ,胃大部切除的概念基本形成 ,定义为切除胃远端的 6 6 %～ 75 % ,这就意味着切除了分泌胃酸和胃蛋白酶和大部分胃体以及分泌胃泌素的幽门窦部。至此 ,在整个消化性溃疡的外科治疗中Billroth胃大部切除术曾一度占居着统治地位[1] 。尽管胃大部切除术治疗溃疡病取得较好效果 ,但以牺牲胃大部分组织为代价 ,而这种代价会损伤胃的储存、研磨和节律性排空功能 ,术后可能出现一系列营养及消化吸收功能障碍…     

An electromyographic study on the canine gastric motility following segmental gastrectomy with selective proximal vagotomy

In order to clarify the gastric motility after segmental gastrectomy (SG) with selective proximal vagotomy (SPV), seventeen canines equipped with four bipolar electrodes on the anterior wall of the stomach underwent four types of operation: 1-group, SG (middle corpus) with SPV-6 dogs; 2-group, SG (middle corpus) with SPV and pyloroplasty-5 dogs; 3-group, SG (upper corpus) with SPV-3 dogs; 4-group, SG (middle corpus) with antral vagotomy (AV)-3 dogs. 1-group: In the preanastomosis, the basic electrical rhythm (BER) frequency was not altered significantly, but the propagation velocity of the BER decreased by about 2 to 20% in the late postoperative period. In the postanastomosis, the BER frequency was markedly reduced, but progressively recovered to show the synchronization with that in the preanastomosis following 15 to 30 days postoperation. The propagation velocity of the BER decreased by about 3 to 25% in the late postoperative period. In the postanastomosis, dysrhythmias were observed to occur in high incidence in the early postoperative period, ut were transient occurrence. 2-group: The high-frequency-dysrhythmias (about 10 cycles/min) were observed. Pyloroplasty increased the frequency of dysrhythmias due to deranging the electric insulator of the pyloric ring. 3-group: In the late postoperative period, the BER frequency didn't synchronize with that in the preanastomosis in fasting. 4-group: Dysrhythmias were observed to occur in the late postoperative period. It was suggested that the gastric motility of the SG with SPV recovered in the late postoperative period, therefore pyloric ring can be preserved.     

Postoperative results of distal partial gastrectomy,selective vagotomy plus antrectomy,and selective proximal vagotomy for duodenal ulcers

We investigated the postperative results of distal partial gastrectomy, selective vagotomy plus antrectomy, and selective proximal vagotomy, to evaluate their effectiveness in the treatment of duodenal ulcers. The operative mortality of selective vagotomy plus antrectomy and selective proximal vagotomy seemed to be lower when compared to distal partial gastrectomy, although each procedure showed a sufficiently low mortality. The acid reduction rate was significantly lower after selective proximal vagotomy than after the other procedures (p<0.01). However, the rate of ulcer recurrence following selective proximal vagotomy tended to be higher compared with the other procedures. All three procedures showed good results according to Visick’s grading and postoperative symptoms occurred in about 50 per cent of all patients, no matter what the procedure. The regaining of physical ability was significantly greater following selective proximal vagotomy than following distal partial gastrectomy (p<0.05) and the capacity to work was also better after vagotomy, particularly selective vagotomy plus antrectomy (p<0.05). Thus, although distal partial gastrectomy and selective vagotomy plus antrectomy proved superior regarding the low ulcer recurrence rate and acid reduction, while selective proximal vagotomy proved superior for improving the quality of life, on the whole the three operations promise almost equivalent results.