Vagotomy : Latest Advances with Special Reference to Gastric and Duodenal Ulcers Disease

This monograph is a summary of observations collected over the past ten years on vagal denervation of the stomach and the functional pathology of the vagotomized stomach. It is primarily a continuation of the work we (Holle and Heinrich, 1954) began with fundectomy - the prototype of proximal dener­ vation of the stomach. This was the starting point for the develop­ ment of selective proximal vagotomy (SPV). Between 1961 and 1964 the SPY technique was developed to the extent that it could be applied clinically from January 1,1964. Like most clinical innovations, the development took place in several stages. A report on the first 235 surgical cases (1961-1967) appeared in 1968 in F. Holle's Special Surgery of the Stomach, pp. 508-509, and in 1969 in Surgery of the Stomach and Duodenum by Harkins and Nyhus, 2nd edition, pp. 629-634. Since that time it has been possible to demonstrate on the basis of 1200 operated cases as well as animal experiments that the new technique we introduced represents a successful, nonresecting surgical treatment of gastric and duodenal ulcers. It is important to have a long series of clinical cases from the same source, because it is not until a large number of individual observations have been collected concern­ ing complications of diagnosis, indications and technique that is it possible to analyse the relationships between them. Front Matter....Pages I-XII Historical Outline....Pages 1-5 Functional Anatomy of the Vagus Nerves in the Upper Abdomen....Pages 6-14 Morphology of Gastric Parietal and Zymogen Cells....Pages 15-18 The Gastrin-Producing Cell....Pages 19-23 The Effect of Selective Proximal Vagotomy on Parietal Cells in Man....Pages 24-32 Changes in the Pyloric-Antral Nervous Tissue Accompanying Gastric and Duodenal Ulcers....Pages 33-37 Gastric Acid Secretory Mechanisms....Pages 38-44 Effects of Vagotomy on Gastric Acid Secretion....Pages 45-52 Gastro-intestinal Hormones — their Release and Influence on Secretion and Motility....Pages 53-58 The Effect of Vagotomy on Circulating Gastrin....Pages 59-64 Effect of Proximal Gastric Resection (Fundectomy) on Gastric Secretion and Motility....Pages 65-67 Effect of SPV on Gastric Secretion in Dogs in Insulin Tests and Sham Feeding....Pages 68-71 Effect of Pyloroplasty on Gastric Secretion after SPV and SV in Dogs....Pages 72-74 Effect of Exogenous Gastrin on the SP-Vagotomized Stomach in Man....Pages 75-76 Significance of a Feeding Test with Check of Serum-Gastrin in Man and Dog....Pages 77-86 The Effect of SPV and Pyloroplasty on Pepsin Secretion in Man....Pages 87-88 Gastric Secretion and Motility after Highly Selective Sympathectomy....Pages 89-93 Advances in Clinical and Experimental Studies on Vagotomy in Japan....Pages 94-94 Indispensability of Vagal-Antral Rami for Preserving Gastric Motor Function after Vagotomy....Pages 94-98 Effects of Various Types of Vagotomy with and without Pyloroplasty on Gastric Acid Secretion in the Dog....Pages 99-102 Effect of Selective Proximal Vagotomy on Gastric Motility and VB 12 Absorption in Duodenal Ulcer Patients (Preliminary Report)....Pages 103-105 Functional Classification of Vagal Afferent Discharges in the Stomach of the Dog....Pages 106-108 Acute and Long-term Effects of Vagotomy on Gastric Mucosal Blood Flow....Pages 109-112 Vagotomy and Cholelithiasis....Pages 113-115 Regeneration of the Vagus Nerve....Pages 116-117 Stress Ulcer and Unilateral Truncal Vagotomy....Pages 118-121 Etiology of the Stress Ulcer....Pages 122-123 Model of the Regulation of Secretion and Motility of the Stomach as a Feedback Circuit and its Practical Application....Pages 124-126 Clinical Aspects of Vagotomy....Pages 127-132 Pre- and Postoperative Secretory Tests....Pages 133-146 X-Ray Checks after Selective Proximal Vagotomy Combined with Various Drainage Operations....Pages 147-159 Gastric Emptying after Selective Proximal Vagotomy....Pages 160-162 Special Indications for Operation and its Progress through SPV....Pages 163-166 Operating Technique of SPV and Pyloroplasty....Pages 167-177 Special Technique of Pyloroplasty (with Special Choice of Method)....Pages 178-188 Clinical Application of the Method of Operations Based on Form and Function....Pages 189-192 Clinical Results....Pages 193-196 SPV and Pyloroplasty in Ulcer Disease....Pages 198-205 Vagotomy in Ulcer Complications....Pages 206-219 SPV in Hiatal Hernia....Pages 220-221 SPV in Cardiospasm....Pages 222-223 Postoperative Treatment and its Complications....Pages 224-226 Critique and Summary....Pages 227-232 Back Matter....Pages 233-244