Hans Schutte

Prospective randomized study comparing three surgical techniques for the treatment of gastric outlet obstruction secondary to duodenal ulcer

A prospective randomized clinical trial was performed in order to evaluate the results of three surgical techniques for the treatment of gastric outlet obstruction secondary to duodenal ulcer. Ninety patients with clinical and laboratory evidence of gastric retention were enrolled. After laparotomy, patients underwent either highly selective vagotomy (HSV) + gastrojejunostomy, HSV + Jaboulay gastroduodenostomy, or selective vagotomy (SV) + antrectomy. One patient died after HSV + Jaboulay gastroduodenostomy due to postoperative acute pancreatitis. There were no differences in the postoperative course of the three groups. Patients were followed for a mean of 98 months (range: 30 to 156 months). There was a significantly better result after HSV + gastrojejunostomy than after Jaboulay anastomosis (p < 0.01), but not after SV + antrectomy. Gastric acid reduction was similar in the small group of patients studied. We propose HSV + gastrojejunostomy as the treatment of choice in patients with duodenal ulcer and gastric outlet obstruction.