Gastric peptic ulcer operation is designed to reduce gastric secretion, of gastric acid and pepsin enough to control the peptic ulcer diathesis and also to have least complications after operation which are related to alterations of gastric motility and emptying rate. The author studied the physiologic effects of proximal gastric vagotomy with pyloroplasty on the gastric secretion, gastric acid, gastric pepsin, gastric motility and gastric emptying rate by means of the ballon-physiographic method through gastric fistula. In this exprimental studies, 2 kinds of animal i.e. dogs and cats were used. 15 dogs were used which were divided into 5 groups i.e. gastrostomy for control, proximal gastric vagotomy, truncal vagotomy only and truncal vagotomy with gastric pyloroplasty. Cats were used 25 ones which were divided into 3 groups i.e. gastrostomy for control, proximal gastric vagotomy and truncal vagotomy and following results and conclusion were obtained. 1. Important role on the gastric secretion, gastric acid, gastric pepsin, gastric motility, gastric emptying and the relationship between the intragastric pressure and volume.2. Both proximal gastric vagotomy and subtotal gastrectomy(Billroth II) made a marked reduction on the gastric secretion, gastric acid and gastric pepsin than that of control group but were similar to control group on the gastric motility and gastric emptying rate. 3. Truncal vagotomy alone caused marked reduction on gastric secretion, gastric acid and gastric pepsin and showed remarkable slowness on gastric motility and gastric emptying rate. 4. The wave of contraction and motility index in duodenum were more higher than that gastric body and antrum and antral contraction is higher than that of gastric body in control groups. 5. Pacesetter potential is formed by intrinsic myogenic phenomena and is related to motor activity and gastric emptying. 6. Truncal vagotomy with pyloroplasty hastened the gastric emptying rate of liquid meals and rate of emptying of solid meals was slightly faster than that of control groups. 7. Emptying of liquid meal is controlled by intragastric transmural pressure and emptying of solid meal is controlled by antral contraction. 8. The vagus distributed on the stomach was divided into cholinergic excitory fibers and noncholinergic or nonadrenergic inhibitory fibers. As gastric vagal inhibitory fibers were cut when vagotomy was done, pyloroplasty was must be done.
Animals ; Cats ; Disease Susceptibility ; Dogs ; Duodenum ; Gastric Acid ; Gastric Emptying ; Gastric Fistula ; Gastrostomy ; Meals ; Motor Activity ; Pepsin A ; Peptic Ulcer* ; Stomach ; Vagotomy ; Vagotomy, Proximal Gastric ; Vagotomy, Truncal

BACKGROUND: The aim of this study is to show the effectiveness and the safety of laparoscopic surgery for the treatment of complicated duodenal ulcers. METHODS: From September 1994 to July 1997, 30 hemodynamically stable patients underwent laparoscopic surgery for the treatment of complicated duodenal ulcers, including 13 free perforations, 12 obstructions and 5 intractabilities. Operations consisted of a truncal vagotomy with a drainage procedure, a proximal gastric vagotomy (posterior truncal vagotomy with anterior seromyotomy) and simple closure of the perforation in 16, 9, 5 cases, respectively. In the beginning of this study, congo-red tests were attempted in 12 patients, intraoperatively in 7 and postoperatively in 5, to assess the reliability of a laparoscopic vagotomy. Long-term follow up was evaluated using by modified Visik criteria. RESULTS: The mean operation time was 150 (80-230) minutes. Oral intake resumed on the third postoperative day. The mean hospital stay was 8.4 days. There was one intraoperative open conversion. In another case, a distal subtotal gastrectomy followed due to persistent postoperative gastric stasis. Six of 7 intraoperative congo red tests showed black-to-red discoloration of the gastric mucosa, which meant reduced gastric acidity. However, in the postoperative group, only 2 of 5 cases did. The mean follow-up period was 21 (3-38) months. There were 2 recurrent ulcers. One was on the duodenum; the other was a marginal ulcer. CONCLUSIONS: Laparoscopic surgery for the treatment of complicated duodenal ulcers is technically feasible, effective, and safe.
Congo Red* ; Congo* ; Drainage ; Duodenal Ulcer* ; Duodenum ; Follow-Up Studies ; Gastrectomy ; Gastric Acid ; Gastric Mucosa ; Gastroparesis ; Humans ; Laparoscopy ; Length of Stay ; Peptic Ulcer ; Ulcer ; Vagotomy* ; Vagotomy, Proximal Gastric ; Vagotomy, Truncal

OBJECTIVESTo study the long-term results of selective vagotomy plus antrectomy in treatment of duodenal ulcer.

METHODSOne hundred and ninety-three patients with duodenal ulcer were subjected to selective vagotomy plus antrectomy from November 1977 to November 2001. These patients included 28 patients with refractory ulcer, 112 with recurrent bleeding, 41 with pylori obstruction, and 12 with duodenal and gastric ulcer.

RESULTSBAO, IMAO, PMAO and serum gastrin were decreased significantly after an 1 - 24-year follow-up after selective vagotomy plus antrectomy. The characteristics of inhibitory secretive were observed in parietal cells. Follow-up after operation for 1 - 10 years and 11 - 24 years showed that 95.60% and 96.61% of patients belonged to Visick grade I and II, and 4.40% and 3.39% of patients belonged to Visick grade III, respectively. No ulcer recurrence was seen during the 1 - 24 year follow-up after the operation.

CONCLUSIONSV + A is an effective method for duodenal ulcer, especially for complicated duodenal ulcer, with permanent reduction of gastric acid and no recurrence.

Adult ; Digestive System Surgical Procedures ; Duodenal Ulcer ; surgery ; Female ; Humans ; Male ; Pylorus ; Treatment Outcome ; Vagotomy, Proximal Gastric

OBJECTIVETo evaluate the long-term therapeutic efficacy of extended parietal cell vagotomy (EPCV) in the treatment of duodenal ulcer complicated with acute perforation.

METHODSTherapeutic efficacy of EPCV in 176 cases subjected to duodenal ulcer with acute perforation since 1979 was evaluated, including postoperative complication, ulcer recurrence rate, gastric empting function, endoscopic and radiographical examination, nutritional status and Visick classification.

RESULTSAmong 176 patients, 153 (86.9%) cases were successfully followed-up for 5 years after operation. No operative death was found. Postprandial superior belly fullness occurred in 13 cases (8.5%) and heartburn in 12 cases (7.8%), which could be relieved by Domperidone. Adhesive ileus was noted in 4 cases (2.6%) which was cured by adhesiolysis. The total ulcer recurrence rate was 2.6% (4 cases) within 2 to 3 years after operation. Superficial gastritis occurred in 21 cases (13.7%) and duodenal bulb in 31 cases (20.3%). Sinus ventriculi vermicular motion was good and gastric emptying was normal. No anemia was found. Body weight gained in 116 cases (75.8%). One hundred and forty-six cases(95.4%) were reforming Visick grade I and II , 3 cases(2.0%) grade III , and 4 cases (2.6%) IV .

CONCLUSIONSEPCV is convenient for performance with low postoperative complication rate. Its long-term efficacies are quite good, which including normal nutritional status, high quality of life and low ulcer recurrence rate. EPCV is one of effective and safe treatments for duodenal ulcer complicated with acute perforation.

Adolescent ; Adult ; Aged ; Duodenal Ulcer ; complications ; surgery ; Female ; Humans ; Male ; Middle Aged ; Peptic Ulcer Perforation ; etiology ; surgery ; Treatment Outcome ; Vagotomy, Proximal Gastric ; Young Adult

OBJECTIVETo study the long-term curative effects of suture plus proximal gastric vagotomy (PGV) and suture plus triad-therapy (omeprazole, amoxycillin and flagyl taken orally) for the treatment of duodenal ulcer with acute perforation.

METHODSThree hundred and twenty-nine patients with duodenal ulcer and acute perforation were treated with 2 different methods, respectively. Method A was suture plus PGV (group A, 153 cases), and method B was suture plus triad-therapy (group B, 176 cases). Follow-up was made by means of correspondence, outpatient reexamination and cooperation with local hospitals in 5 to 8 years after operation. The contents of follow-up included symptom acquisition (such as upper abdominal pain or distention, pyrosis, belch, acid regurgitation, vomiting, diarrhea and conditions of living or working), gastroscopy and Helicobacter pylori (HP) detection. The curative effects were evaluated by the Visick scale.

RESULTSThree hundred and one patients were followed up (group A 142 and group B 159). According to the Visick scale, 97 (68.3%), 19 (13.4%), 13 (9.15%) and 13 (9.15%) patients in group A, and 31 (19.5%), 28 (17.6%), 24 (15.1%) and 76 (47.8%) in group B were classified as Visick I, II, III and IV respectively (Z = -9.818, P < 0.01). As for HP detection, there were 130 (91.5%) patients in group A and 94 (59.1%) in group B (chi(2) = 41.438, P < 0.01).

CONCLUSIONSThe long-term curative effects of suture plus PGV were superior to those of suture plus triad-therapy for duodenal ulcer with acute perforation although HP positive rate was higher in group A than in group B. HP infection is one of the etiological factors of duodenal ulcer. The increased excitability of the vagus nerve remains to play an important role in duodenal ulcer.

Acute Disease ; Adolescent ; Adult ; Aged ; Amoxicillin ; administration & dosage ; Drug Therapy, Combination ; Duodenal Ulcer ; drug therapy ; etiology ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Metronidazole ; administration & dosage ; Middle Aged ; Omeprazole ; administration & dosage ; Peptic Ulcer Perforation ; drug therapy ; surgery ; Suture Techniques ; Vagotomy, Proximal Gastric ; methods