Treatment of perforated duodenal ulcer by vagotomy-associated antrectomy.

In the years between 1967 and 1978, Billroth I-type antrectomy and truncal vagotomy were performed in 44, and primary gastric resection in 19 cases of perforated duodenal ulcer. It was found that in the case of perforated ulcer causing extensive scarring, stenosis or penetration, antrectomy is not more complicated than pyloroplasty. In the absence of other local lesions and mainly in high-risk patients with cirrhosis, diabetes, chronic renal disease, tuberculosis, etc. excision of the perforated duodenal ulcer, pyloroplasty according to Finney and vagotomy were performed (48 operations), while in purulent peritonitis (8 patients) suturing only was applied. Bearing in mind the above aspects, the authors lost none of their patients. Final and similar results can be achieved with performed (in 48 cases), while in the case of purulent peritonitis only suturing was applied in 8 patients. None of the patients was lost. Similar results can be achieved with emergency antrectomy and vagotomy as under elective conditions. In the majority of cases the perforated duodenum can be operated upon in such a way which will abolish the perforation and ensure a final healing of the ulcer.