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Article
December 1962

Combined Operation: Vagotomy, Antrectomy, and GastroduodenostomyUse in Surgical Treatment of Duodenal Ulcer

Author Affiliations

SEATTLE
Professor and Executive Officer, Department of Surgery, University of Washington School of Medicine (Dr. Harkins); Instructor in Surgery, University of Washington School of Medicine, (Dr. Chapman); Associate Professor of Surgery, University of Washington School of Medicine (Dr. Nyhus); Postdoctoral Research Fellow, National Heart Institute (Dr. Condon); Assistant Professor of Surgery, University of Washington School of Medicine (Dr. Stevenson); Assistant Professor of Surgery, University of Washington School of Medicine (Dr. Jesseph).; From the Department of Surgery, University of Washington School of Medicine.

Arch Surg. 1962;85(6):936-943. doi:10.1001/archsurg.1962.01310060072015
Abstract

In the initial portion of this paper the "combined operation" will be discussed from 2 standpoints, first, physiologic basis, and second, technique. Each of these 2 headings will be further discussed regarding the 3 main steps of the procedure: vagotomy, antrectomy, and gastroduodenal anastomosis, considering the physiologic basis and then the technical performance, respectively, of each of these steps. The paper will close with a brief presentation of our clinical experience and a conclusion.

I. Physiologic Basis of the Combined Operation  Medical and surgical therapy of peptic ulcer disease alike depend upon decreasing or neutralizing the secretion of acid and pepsin (Fig. 1). The success of the combined operation is the result of its ability to alter normal mechanisms of gastric secretion and to block the pathways over which abnormal secretory stimuli are known to operate.Gastric juice is produced only in response to specific stimuli that are divided into

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