Vagotomy and Pyloroplasty in Chronic Duodenal Ulcer with Special Reference to Technique

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Abstract
Introduction The surgical treatment of duodenal ulcer is controversial. The literature is replete with enthusiastic testimonials for a host of surgical maneuvers presumably effective in altering the ulcer diathesis. Regardless of one's conviction as to the operation of choice for duodenal ulcer, vagotomy, as well as various types of gastrectomy, should be included in the armamentarium of those responsible for the training of surgeons. Because a gross variation in results achieved from vagotomy and complementary procedures exists, it seems reasonable that there may be fundamental differences in technique in various centers. The multiplicity of the factors involved, coupled with the fallibility of human observation, adds to the controversy. Success of this operation depends on certain technical features, which serve as the basis for this report. Subtotal gastrectomy, pyloroplasty, and gastrojejunostomy have all benefited ulcer patients in varying degrees, through extirpation of acid-secreting mucosa, through some neutralization effect, or through a

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