SUBTOTAL GASTRECTOMY WITH AND WITHOUT VAGOTOMY FOR DUODENAL AND GASTROJEJUNALN ULCER

Abstract

• Subtotal gastrectomy alone was done in 224 patients and combined with infradiaphragmatic vagotomy in 217 patients who had duodenal and gastrojejunal ulcer. Of the three operative deaths, two were in the latter group but could not be ascribed to the vagotomy. Of the 17 proved instances of recurrent peptic ulcer disease, only one was in the vagotomized group. Vagotomy entailed an increase in postoperative morbidity and a risk of prolonged moderate diarrhea, but it afforded some protection against subsequent jejunal ulceration. Gastroenterostomy was done in 101 patients, with vagotomy in 70 of these. The rate of recurrences was 15 % in the patients without and 10 % in the patients with the vagotomy. It appeared that vagotomy afforded little protection to the patients with gastroenterostomy. A continuation of the subtotal gastrectomy of the Billroth 2 type, preferably combined with vagotomy, is recommended on the basis of this experience.