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October 1960

The Antrum: Its Role in the Surgery of Duodenal Ulcer

Author Affiliations

From the Department of Surgery, University of Washington School of Medicine.; Fellow, National Institutes of Health (Dr. Chapman); Professor and Executive Officer, Department of Surgery (Dr. Harkins), Associate Professor, Department of Surgery (Dr. Nyhus), University of Washington School of Medicine.

Arch Surg. 1960;81(4):517-524. doi:10.1001/archsurg.1960.01300040001001

Because the antrum is the source of the acid secretion stimulating hormone gastrin, it has been believed that a successful operation for duodenal ulcer includes removal of the antrum. Contrary to this view, we now know that the antrum can be retained, provided certain criteria are followed.

If the antrum is retained, it must

( 1 ) be vagally denervated;

(2) remain in the acid stream;

(3) have antral stasis prevented.

The experimental basis for these criteria will be presented together with a brief review of the effect of various surgical procedures upon the antrum (Fig. 1).

Experimental Normal Mechanisms of Gastric Acid Secretion  A. Antral Stimulatory Mechanisms for Gastrin ReleaseEdkins in 1906 demonstrated that the antral mucosa contained a hormone (gastrin) which, when injected intravenously, produced a copious secretion of HCl from a denervated stomach.Gastrin is released from the antrum in response to specific stimuli, which are:(1) Vagal: