Rationale of Vagotomy and Pyloroplasty in Management of Bleeding Duodenal Ulcer

The fundamental problem in the treatment of peptic ulcer is to correct the abnormal neural and humoral phases of gastric activity. The fact that a given ulcer bleeds does not essentially alter this problem. On the basis of these premises the policy has been adopted, in the surgical treatment of ulcer, of performing vagotomy before pyloroplasty when the procedure is elective but reversing this order when there has been acute hemorrhage; in the latter case gastroduodenotomy is done immediately upon opening the abdomen to permit early visualization and treatment of the bleeder. These conclusions are based especially upon experience with 21 patients who were bleeding severely at the time of the operation or had severe hemorrhages immediately before operation. In this group there has not been a single instance of subsequent bleeding, proved recurrence of ulcer, or death. Three case histories illustrate the complete recovery of patients in whom this policy was followed.