Vagotomy; the present position.

The operation of vagotomy was suggested as long ago a's I812 by Brodie and was tried in cases of gastric crises by Exner and Schwatzman in 1912, and Latarjet in 1923. Bircher (1920), Steirlin (1920) and Schiassi (I925) reported good results in peptic ulcer, but the results do not appear to have been lasting and others who tried the operation were soon disappointed. Not until 1942 was really complete interruption of all vagal fibres entering the abdomen attempted, and it is now realized that only ifthe division is complete are the results lasting. Dragstedt, who was the pioneer of the complete operation, and who has performed 350 vagotomies, states that the results, even after nearly five years, continue to be so satisfactory that the operation has replaced all other procedures for peptic ulcer in his clinic (Dragstedt, personal communications). Vagotomy is now passing out of the experimental stage and is becoming established on a firm basis. There is no longer any doubt that, provided all vagal fibres are cut, the subsequent history of patients with peptic ulceration is altogether altered. Although the total number of vagal resections on record is now many hundreds, no case of subsequent perforation has been reported among them, and of those established as complete by the insulin test the very great majority have remained completely free from symptoms.