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August 1947

GASTRIC NEURECTOMY: Anatomic and Physiologic Studies with Favorable and Unfavorable Results in the Treatment of Peptic Ulcer

Author Affiliations

Fellow in Surgery; Fellow in Medicine; Fellows in Surgery, Mayo Foundation ROCHESTER, MINN.
From the Division of Surgery, Mayo Clinic (Dr. Walters) and the Mayo Foundation.

Arch Surg. 1947;55(2):151-163. doi:10.1001/archsurg.1947.01230080156005

DRAGSTEDT'S1 report in 1946 on the section of vagus nerves in 54 cases of peptic ulcer with favorable results, similar reports by Grimson,2 Ruffin and co-authors3 concerning 30 cases at Duke University, and by Moore and his associates4 concerning 12 cases at the Massachusetts General Hospital led us to study the problem of resection of vagus nerves, or, as we prefer to call the operation, "gastric neurectomy," from the anatomic, physiologic and chemical standpoint in 40 patients operated on by one of us at the Mayo Clinic up to Jan. 15, 1947 (tables 1 and 2). Only brief reference will be made to 43 additional cases in which operation was performed by other surgeons at the clinic, for they will individually report on their results in detail later.

HISTORICAL DATA  Denervation of the stomach in the treatment of pain and peptic ulcer is not a new

Dragstedt, L. R.:  Section of the Vagus Nerves to the Stomach in the Treatment of Gastro-Duodenal Ulcer ,  Minnesota Med. 29:597-604 ( (June) ) 1946.
In Grimson's most recent report (unpublished) on the results of the operation in 57 cases, he described disturbances in motility in 25. In 6 cases there was severe gastric retention which necessitated gastroenterostomy. This gave an incidence of secondary gastroenterostomy of 1 among each 7 patients who had not had a previous drainage operation.
Grimson, K. S.: Unpublished data.
Grimson, K. S.; Taylor, H. M.; Trent, J. C.; Wilson, D. A., and Hill, H. C.:  The Effect of Transthoracic Vagotomy upon the Functions of the Stomach and upon the Early Clinical Course of Patients with Peptic Ulcer ,  South. M. J. 39:460-470 ( (June) ) 1946.Crossref
Ruffin, J. M.; Grimson, K. S., and Smith, R. C.:  The Effect of Transthoracic Vagotomy upon the Clinical Course of Patients with Peptic Ulcer ,  Gastroenterology 7:599-606 ( (Dec.) ) 1946.
Moore, F. D.; Chapman, W. P.; Schultz, M. D., and Jones, C. M.:  Trans-diaphragmatic Resection of the Vagus Nerves for Peptic Ulcer ,  New England J. Med. 234:241-251 ( (Feb. 21) ) 1946.Crossref
Brodie, B. C., cited by Hartzell.7
Latarjet, A.:  Note préliminaire sur l'innervation et l'énervation de l'estomac ,  Lyon méd. 130:166-167, 1921
 Résection des nerfs de l'estomac: Technique opératoire; résultats cliniques ,  Bull. Acad. de méd., Paris 87:681-691, 1922.
Hartzell, J. B.:  The Effect of Section of the Vagus Nerves on Gastric Acidity ,  Am. J. Physiol. 91:161-171 ( (Dec.) ) 1929.
Vanzant, F. R.: The Late Restoration of Gastric Acidity After Thoracic Vagotomy in the Dog, Gastroenterology, to be published.
This case will be referred to again in the section on "Recurrence of Ulcer or Failure of Ulcer to Heal: Both Series."
This case will be referred to again in the section on "Recurrence of Ulcer or Failure of Ulcer to Heal: Both Series."
Colp, R.: Unpublished data.
Schiff, L.: Personal communication to the authors.
Weeks, C.; Ryan, B. J., and Van Hoy, J. M.:  Two Deaths Associated with Supradiaphragmatic Vagotomy ,  J. A. M. A. 132:988-990 ( (Dec. 21) ) 1946.Crossref