Clinical and radiological study of vagotomy and gastric drainage in the treatment of pyloric stenosis due to duodenal ulceration.

Although vagotomy combined with gastric drainage is now a well-established procedure in the surgical treatment of duodenal ulcer, it has been suggested by a number of authorities that it is contraindicated in those cases which are complicated by pyloric stenosis (Moore, Chapman, Schulz, and Jones, 1947; Bergin and Jordan, 1959; Kraft, Fry, and DeWeese, 1964; Mialaret, 1964; Capper, 1965.) After vagotomy, gastric mobility is diminished as a result of the loss of extrinsic nerve supply to the stomach; subsequently it is partially restored through a peripheral motor mechanism mediated by the intrinsic nerve plexus in the stomach wall (Dragstedt, Harper, Tovee, and Woodward, 1947). It has been argued that the decompensated musculature of the stomach, dilated as a result of pyloric obstruction, might be more susceptible to the atonic influence of vagotomy (Bergin and Jordan, 1959) and that prolonged gastric atony is likely to follow this operation. This paper presents a clinical and radiological study of 21 patients with gross pyloric stenosis due to duodenal ulceration, all of whom were treated by vagotomy combined either with gastro-jejunostomy or pyloroplasty. The immediate and long-term clinical results were satisfactory in all 21 cases. Subsequent barium meal series in 20 of these patients showed that the dilated stomachs had returned to normal tone and size with satisfactory emptying. From this investigation it is argued that vagotomy and gastric drainage, far from being contraindicated, is the treatment of choice in this condition. 67 8 CLINICAL STUDY