Gastroenterostomy and pyloroplasty after vagotomy. A comparison of these procedures in protecting dogs against histamine-provoked peptic ulcers.

The surgical treatment of duodenal ulcer has long revolved about the question whether to resect a substantial part of the acid-producing stomach or to inhibit the neurohormonal mechanisms responsible for gastric juice production by more conservative operative means. Gastric vagotomy combined with an adequate drainage procedure has gained increasing recognition as a duodenal ulcer operation without most of the dismaying after-effects of gastric resections. Vagotomy alone will not prevent duodenal ulcers. Dragstedt, 1 among many investigators, presented clear experimental evidence that vagotomy results in stimulation of the gastric phase of secretion due to stagnation of food in the antrum. Drainage of the vagotomized stomach at its most dependent part through a gastrojejunostomy could thus be expected to remove this hormonal stimulus and to decrease the gastric juice production below the ulcerogenic threshold. While vagotomy will block the neurocephalic phase of gastric secretion at the expense of gastric atony, gastrojejunostomy, intended