Gordon Knight Smith

Vagotomy and pyloroplasty for bleeding duodenal ulcer. A note on selective vagotomy.

Abstract 1. 1. Seventy-six patients with bleeding duodenal ulcer and treated by vagotomy and pyloroplasty are reported. 2. 2. Fifty of these patients qualify as massive bleeders with hemoglobin levels of 8 gm. per cent or less and/or required at least 2,000 ml. of blood. A third criterion for definition of massive bleeding: namely, shock is proposed. 3. 3. The success of this operation depends upon an accurate vagotomy, a firm ligature of the bleeding vessel and a good functioning pyloroplasty. 4. 4. Preliminary experiences with forty selective vagotomy operations over a two year period are reported. 5. 5. Three deaths have occurred in the entire group. One of these could have been prevented by reoperation. In two other patients death occurred from causes other than continued hemorrhage. 6. 6. Of the remaining seventy-three patients, two others have required reoperation for bleeding (late), one for recurrent duodenal ulcer and the other for diffuse gastritis. 7. 7. Accumulative data from these experiences indicate over a twelve year period that correction of the abnormal cephalic and humoral phases of gastric hypersecretion associated in man with chronic duodenal ulcer may be effectively corrected by vagotomy and pyloroplasty. Cognizance of this experience is important to those who are dealing with a patient who is a poor risk and who is suffering from hemorrhage and in whom more formidable operations might be poorly tolerated.

Reappraisal of the long-term effects of selective vagotomy☆☆☆

A theoretic justification for selectively denervating the stomach exists in the possibility that certain undesirable side effects of truncal vagotomy may well be associated with denervation of extragastric viscera, that is, the biliary duct system, pancreas, and small intestine. Because of this consideration, a clinical study was begun in 1960 and a preliminary report made in 1963 upon forty patients who had undergone some type of selective vagotomy for peptic ulceration. In order to identify the various types of vagotomy, we divided the operation into four types: total vagotomy (type I) ; bilateral selective vagotomy (type 11) ; anterior selective vagotomy with sacrifice of the posterior nerve (type III) ; and posterior selective vagotomy with sacrifice of the anterior nerve (type IV). Burge [1] of the West London Hospital indicated that the genesis of diarrhea and color change in bowel movement was related more to the anterior than the posterior nerve. However, in a later communication [Z] he revised this opinion and stated that preservation of both nerves was important. The present report is concerned with seventy-three patients, the first being operated upon in October 1960 and the last in December 1966. Our initial enthusiasm for the procedure, although modest, led us to continue the study and further postoperative observations have ultimately led to abandonment of the operation in December 1966.

Long-term appraisal of the treatment of gastric ulcer in situ by vagotomy and pyloroplasty: With a note on the jaboulay procedure

Forty-six patients with gastric ulcer are reported on in whom vagotomy and pyloroplasty rather than conventional gastrectomy were carried out. Ninety per cent of these patients achieved a good longterm result. When biopsy shows the ulcer to be benign, operations of lesser magnitude such as vagotomy and pyloroplasty are clearly indicated particularly in the treatment of high lying gastric ulcers, poor risk patients, or both.