Reestablishing duodenal continuity after previous gastrectomy for peptic ulcer

Gastroduodenal anastomosis is not routine during reoperation for stomal ulcers after primary Billroth II gastrectomy. It nevertheless is a sure way to prevent an increased peptic potential which is brought about by a duodenal bypass. We have reviewed the published cases and added three more, bringing the total to 47. We analyzed the modalities, indications and results of this method. Gastroduodenal anastomosis can be accomplished more often than is thought, despite the often necessary large gastric resections. Separation of the duodenopancreatic block and liberation of the fundus allows suturing without traction. End-to-side anastomosis of the stomach on the anterior wall of the second portion of the duodenum avoids dissection of the duodenal stump. Vagotomy is required when basal acidity is greater than 20 mEq/liter. Reestablishing a physiologic alimentary tract is particularly indicated in chronic obstruction due to stenosis associated with a proximal loop syndrome in young patients. Jejunal interposition becomes necessary when total gastrectomy is the result of repeated surgery. Such a method is the best solution for agastria. The excellent results obtained by gastroduodenal anastomosis after repeat gastrectomy should encourage wider use.