The search continues for a surgical procedure in the treatment of duodenal ulcer which will include low morbidity and mortality rates and low incidence of ulcer recurrence. No available operation yet satisfies all three criteria of success. Gastric surgery evolved from procedures (1881) originally designed to palliate or cure gastric cancer. In the 1930's surgeons recognized the need for removal of large segments of the acid peptic secretory portion of the stomach when dealing with duodenal ulcer. Yet many subtotal gastrectomies have resulted in unphysiologic sequelae such as dumping and weight loss which subtract from their effectiveness as ulcer operations. Since the stomach is a secretory-motor organ, operations designed to ablate the secretory function may fall short of the desired goal because of failure to consider the effect on gastric motor function.
For example, with excision of the pyloric ring in both Billroth 1 and Billroth 2 gastrectomy, the occurrence
Goodale RL, Tsung MS, Prevost M, Edlich RF, Wangensteen OH. Pylorus Preserving Gastrectomy (Maki)Effects Upon Antral Function, Gastric Emptying and Ulcerogenesis in the Dog. Arch Surg. 1969;99(2):193-197. doi:10.1001/archsurg.1969.01340140065010