Anterior Pylorectomy and Vagotomy for Complicated Peptic Ulceration

This article reviews the treatment of duodenal and gastric ulcer when complicated by haemorrhage, performation and obstruction. Support is given for the use of anterior pylorectomy and vagotomy, carried out at the time when the emergency is dealt with, as the preferred long-term procedure in the management of these conditions. Summary 1. Bleeding duodenal ulcers are successfully treated by vagotomy and ligation of the bleeding point in combination with anterior pylorectomy and a personal series of nine cases illustrates this method. There are also certain advantages of such a conservative surgical approach over partial gastrectomy. 2. The technique of anterior pylorectomy for bleeding cases differs slightly from that used for uncomplicated cases. 3. Vagotomy with anterior pylorectomy for perforated duodenal ulceration is a safe and definitive operation. Its advantages over simple suture or emergency partial gastrectomy are indicated on the basis of a review of recent literature and of a small personal series. 4. The technique of anterior pylorectomy for perforated cases differs slightly from that used for uncomplicated and bleeding cases. 5. The treatment of obstructing duodenal ulceration by vagotomy and anterior pylorectomy may have a place. Pylorectomy, if considered inadequate, will not create technical difficulties with an ensuing gastrectomy. 6. The place of vagotomy and anterior pylorectomy in complicated gastric ulceration and gastric erosions is uncertain, but it can be substantiated on present physiological knowledge.