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[Billroth I hemigastrectomy in complicated recurrent ulcer after selective proximal vagotomy]
G Arlt1, C Peiper, G Winkeltau
1Chirurgische Klinik, Medizinischen Fakultät der RWTH Aachen.
Insights
Billroth I hemigastrectomy effectively treats recurrent ulcers after proximal selective vagotomy (PSV) with low complication rates. This surgical approach offers long-term ulcer recurrence prevention and good patient outcomes.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Digestive System Surgery
Context:
- Recurrent ulcers pose a significant challenge after initial duodenal ulcer treatment.
- Proximal selective vagotomy (PSV) is a common procedure for duodenal ulcers.
- Revision surgery is often complex and associated with higher risks.
Purpose:
- To evaluate the efficacy and safety of Billroth I hemigastrectomy for complicated recurrent ulcers following PSV.
- To assess long-term outcomes, including ulcer recurrence and patient satisfaction (Visick grading).
- To determine the morbidity associated with this revision procedure.
Summary:
- A retrospective study analyzed 15 patients undergoing Billroth I hemigastrectomy for recurrent ulcers post-PSV.
- Follow-up ranged from 15-81 months (mean 3.8 years).
- Complications included bleeding (4), stenosis (5), penetration (3), perforation (1), and refractory ulcers (2). No mortality occurred during revision surgery. 80% achieved good/excellent outcomes (Visick I/II).
Impact:
- Billroth I hemigastrectomy demonstrates low morbidity and effective long-term prophylaxis against ulcer recurrence.
- The procedure yields favorable functional outcomes for patients with complicated recurrent ulcers.
- This surgical strategy offers a reliable solution for managing challenging post-vagotomy ulcer complications.
Abstract:
The outcome of Billroth I hemigastrectomy for complicated recurrent ulcers after proximal selective vagotomy (PSV) for duodenal ulcer was analyzed in a retrospective study of 15 patients followed up for 15-81 months (mean 3.8 years) postoperatively. Bleeding was reported in 4, stenosis in 5, penetration in 3, perforation in 1 and refractory ulcer in 2 cases. None of the patients died during revision surgery, and none developed ulcer recurrence. In 4 patients complications were seen, including bleeding requiring relaparotomy (1) and subhepatic hematoma (3). In 12 patients (80%) a good or excellent result (Visick I/II) was seen at follow-up. Reasons for Visick III or Visick IV classification were reflux esophagitis grades I and II in 2 cases and refractory dyspeptic symptoms in 1 case. Distal gastric resection with a Billroth I anastomosis for complicated recurrent ulcer after PSV proved to involve only low morbidity and to effect reliable prophylaxis of ulcer recurrence in the long term.