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
HARKINS HN, CHAPMAN ND, NYHUS LM, CONDON RE, STEVENSON JK, JESSEPH JE. Combined Operation: Vagotomy, Antrectomy, and GastroduodenostomyUse in Surgical Treatment of Duodenal Ulcer. Arch Surg. 1962;85(6):936-943. doi:10.1001/archsurg.1962.01310060072015