January 1966

Measured Subtotal Gastrectomy for Duodenal UlcerSize of Resection Versus Ulcer Control and Patient Rehabilitation

Author Affiliations

From the departments of surgery, Veterans Administration Hospital, West Roxbury, and Harvard Medical School, Boston.

Arch Surg. 1966;92(1):52-57. doi:10.1001/archsurg.1966.01320190054012

DURING the past 30 years the most common operation for duodenal ulcer has been resection of the distal two thirds to three fourths of the stomach. This procedure, once the standard operation in peptic-ulcer surgery, is now being replaced in many hospitals by vagotomy combined with pyloroplasty or antrectomy. Operations eliminating vagal stimulation probably have a more elegant physiologic rationale to support them1-3; but the loss of enthusiasm for subtotal gastrectomy stems in large part from reports of high ulcer-recurrence rates, poor nutritional results, distressing postprandial symptoms, and relatively high operative morbidity and mortality figures.4-7 The incidence of such complications after subtotal gastrectomy is not uniform, however, and some authors have reported such good operative results that there would seem to be little room left for improvement in an elective procedure, regardless of its physiologic basis.8,9

It seems desirable to determine the reasons behind the disparity in

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