Review of elective surgical treatment of chronic duodenal ulcer

This article is a review of 20 clinical trials of various forms of elective surgical treatment of chronic duodenal ulcer conducted between 1964 and 1975, some of them prospective and others retrospective in nature. Comparisons have been made of the results following truncal vagotomy with drainage, truncal vagotomy with antrectomy, and partial gastrectomy. Additionally, selective vagotomy and truncal vagotomy have been compared in some studies and various forms of drainage, such as pyloroplasty and gastrojejunostomy, have been compared in others. In general, the results of all current forms of elective surgery for chronic duodenal ulcer have been very good, and the differences among the effects of the various procedures have been small. There have been no significant differences in the mortality rates associated with the several operations when they have been performed electively. The rate of ulcer recurrence and incidence of diarrhea have been somewhat higher after truncal vagotomy with drainage, whereas the frequency of dumping and amount of weight loss have been somewhat greater after all forms of gastric resection. Selective vagotomy appears to be associated with less frequent and severe diarrhea than does truncal vagotomy. There have been no apparent differences in the results of the various drainage procedures that have been combined with vagotomy. Highly selective vagotomy without drainage, the most recent operation for duodenal ulcer, has resulted in the lowest incidence of post‐operative side effects of any surgical procedure in current use. However, the frequency of ulcer recurrence after this therapeutic measure remains to be determined by long‐term studies. Résumé Cet article passe en revue 20 études cliniques compilées entre 1964 et 1975 sur le traitement chirurgical électif des ulcères duodénaux chroniques; certaines de ces études sont de nature prospectives, d'autres rétrospectives. On y compare les résultats obtenus par vaguotomie tronculaire avec drainage, vaguotomie tronculaire et antrectomie, et gastrectomie partielle. De plus, dans certaines études, on a comparé la vaguotomie sélective et la vaguotomie tronculaire tandis que d'autres études comparaient différentes formes de drainage, par exemple pyloroplastie et gastro‐jéjunostomie. En général les résultats obtenus ont été très bons et il n'y a pas eu de différence significative entre les diverses formes de traitement chirurgical électif pour ulcère duodénal chronique. Les taux de mortal