Danger of fundoplication after selective vagotomy and antrectomy.

Antireflux procedures are required in some patients at the same time or later after operations for chronic duodenal ulcer. The consequences to gastric blood supply are different between the three vagotomies usually performed to treat duodenal ulcer. A serious ischemic complication, incurred when a patient underwent fundoplication several years after a selective vagotomy and antrectomy, is reported to emphasize that the stomach relies on greater curvature arterial blood supply after this operation. Additional arteries ligated during fundoplication may surpass the capacity of remaining gastric arterial collaterals and produce ischemia. The same danger exists with fundoplication after proximal gastric vagotomy, if antrectomy has been added to treat recurrent ulcer. The technical differences of these two vagotomies from truncal vagotomy and the potential danger of fundoplication in these clinical situations must be recognized by the general surgeon.