Choice of gastric drainage procedures.

The need for drainage after truncal or selective vagotomy is well accepted, but there is no agreement on the most suitable type of drainage procedure. A review of the literature, particularly of papers published in the last 3 years, suggests that whereas vagotomy with gastroenterostomy is followed by a relatively high incidence of bile vomiting, vagotomy with pyloroplasty carries a significantly higher risk of recurrent ulceration. The surgeon, therefore, should not hesitate to perform gastroenterostomy if the pyloroduodenum is severely scarred. As pyloroplasty is irreversible, gastroenterostomy is probably the drainage procedure of choice.