The choice of operative procedure in the surgical management of patients with peptic ulcer has been a long-estabilished dilemma. Although there are available three satisfactory approaches-subtotal gastrectomy, vagotomy with limited gastric resection, and vagotomy with drainage procedure, there is no general agreement which considers any specific operative procedure to be optimal for treatement of peptic ulcer.
Numerous complications after the surgical procedures have been reconignised. And late complications are important in choosing operative procedures. A survey was undertaken of 101 cases with peptic ulcer who had been treated, from January 1970 to December 1980, by subtotal gastrectomy, vagotmy with hemigastrectomy or with pyloroplasty.
The results were as follows.
1) The incidence of dumping sundromes were 16% (10/61) after subtotal gastrectomy, 14% after vagotomy with hemigastrectomy(4/27), and 11% (1/9) after vagotomy with pyloroplasty. The incidence of severe dumping syndromes was 1.6% after subtotal gastrectomy.
2) The incidence of weight loss was 33% after subtotal gastrectomy, 29% after vagotomy with hemigastrectonly, and 22% after vagotomy with pyloroplasty.
3) The incidence of severe diarrhea was 1. 6% after subtotal gastrectomy, 12.5% (1/8) after truncal vagotomy with pyloroplasty. There was no diarrhea in patients treated by selective vagotimy with hemigastrectomy or pyloroplasty (9 cases).
4) The incidence of epigastric pain after meal was 16.4% after subtotal gastrectomy, 14.8% after vagotomy with hemigastrectomy, 11.2% after vagotomy with pyloroplasty.
5) The incidence of flatulence was 35%.
6) Of 101 patients, 11. patients complained about indigestion and 59 patients felt good in. digestion.
7) The recurrence rate of ulcer was 11.5% after subtotal gastrectomy, 11% after vagotomy with pyloroplasty. And there was no recurrence after vagotomy with hemigastrectomy.
8) 80% of patients after subtotal gastrectomy, 85% of patients after vagotomy with hemigastrectOmy, 89% of patients after vagotomy with pyloroplasty were condidered to have an excellent or very good result according to Visick classification.
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