The role of vagotomy in pancreaticoduodenectomy.

In a series of 41 pancreatoduodenectomies the Whipple procedure was done in 27 patients and total pancreatoduodenectomy in 14 others with two postoperative deaths. Among 39 survivors, seven developed evidence of stomal ulcer 20 days to six years after operation; details of their courses are summarized. Proven stomal ulcer occurred in five of 14 patients who did not have concomitant vagotomy with pancreatoduodenectomy (36%). Each of these required vagotomy secondarily in management. When two patients with hematemesis in whom stomal ulcer was suspected but not proven are included, the incidence of stomal ulcer in nonvagotomized patients with pancreatoduodenectomy (7/14) is 50%. There were no stomal ulcers in patients with pancreatoduodenectomy who had concomitant vagotomy (0/25). It is logical to add the protective effects of vagotomy to pancreatoduodenectomy, especially when the disease process favors prolonged survival.