Selective Vagotomy of the Gastric Remnant for Extragastric Ulcer Recurrence Following Resection

Ulcers may be the resultant of overstressed physiological tissue function, in the antrum stimulated by stasis or reduced parietal cell function, in the duodenum when the inhibitory mechanisms are overactivated by increased parietal cell function. Primary and secondary antral ulcers are treated by antrectomy, duodenal ulcers and extragastric recurrent ulcers by selective gastric vagotomy. One of 20 patients died after selective vagotomy of the gastric remnant for extragastric recurrence. Postoperative spontaneous secretions were alkaline in all cases, and 18 of 19 patients were achlorhydric on insulin activation. Pentapeptide-activated secretion was abolished in half the patients and otherwise reduced by 80 per cent.