David J. Gillett

Treatment of the carcinoid syndrome by hemihepatectomy and radical excision of the primary lesion

Abstract Two patients with the carcinoid syndrome whose symptoms were difficult to control with drugs and who had early signs of right heart valvular changes are reported on. Left hemihepatectomy was believed to be justified; resection of the left half of the liver, a tumor of the small bowel, and lymph node secondaries in one patient and resection of a tumor of the small bowel and the quadrate hepatic lobe in another patient resulted in symptom-free periods of twelve and four months, respectively. These cases support the adoption of more aggressive surgical treatment of this manifestation of carcinoid tumors.

Recurrent ulceration after gastroenterostomy or pyloroplasty with complete and incomplete vagotomy

Abstract A series of 191 patients is reported with a mean follow-up period of more than four years after truncal vagotomy and either pyloroplasty or gastroenterostomy. The over-all recurrence rate was 7 per cent (13 of 171), with 5 per cent (7 of 124) after gastroenterostomy and 9 per cent (6 of 67) after pyloroplasty. In patients who had incomplete vagotomy the rate of recurrent ulceration was 10 per cent (3 of 30) after gastroenterostomy and 17 per cent (3 of 18) after pyloroplasty.

The Results of Surgical Treatment for Peptic Ulceration, 1960 ‐ 1964

The results of 530 consecutive operations for peptic ulceration have been assessed and classified as satisfactory or unsatisfactory. The disabilities which determined the result have been analysed, and their incidences after gastrectomy and after vagotomy and drainage compared.

The Surgical Treatment of Pyloric Obstruction due to Peptic Ulceration

The results of surgery in 232 cases of peptic ulcer complicated by pyloric obstruction have been reviewed and the results of different operative procedures compared. SUMMARY In this series vagotomy and drainage gave much better results in the presence of pyloric obstruction than in the treatment of peptic ulcer in general, whereas the results of Pólya gastrectomy appear marginally worse. It appears that the risk of stomal ulceration is the major difference, as the stomal ulcer rate for vagotomy and drainage in the presence of pyloric obstruction was 2% as compared with 8% in the total series. Conversely, the incidence of stomal ulcer following gastrectomy appears to be slightly increased. These findings suggest that vagotomy with drainage is the treatment of choice in pyloric obstruction.