Recurrent Peptic Ulcer Following Primary Operations With Vagotomy for Duodenal Ulcer

Forty-two patients who were failures of definitive surgery, including vagotomy, for chronic duodenal ulcer required another operation. The vagotomy had been accompanied by gastroenterostomy (16 patients), pyloroplasty (16 patients), or gastrectomy (10 patients). The secondary operation was gastric resection in each case (resection of additional stomach in those with previous gastrectomy) and correction of any technical faults from the previous operation. Late results of the secondary operation were good in 25 of 40 patients followed up to 20 years, but seven patients had further ulceration and eight patients had significant functional or nutritional disturbances. The study suggests that total gastrectomy should be performed sooner on patients whose recurrent ulcer follows a satisfactory vagotomy and gastrectomy. The symptomatic failures of secondary gastrectomy in the vagotomy-pyloroplasty group, mostly functional, are perplexing and merit further study.