Pyloric origin of gastric and duodenal ulcers: surgical connotations.

A new theory on cause and treatment of peptic diseases proposes that these disorders result from dysfunction of the pyloric muscle causing delay in gastric emptying of solids. It emphasizes the separate function of the duodenal sphincter and the gastric sphincter components of this muscle. Dysfunction of either results in delayed gastric emptying of solids. Peritoneal patch pyloroplasty (PPP) has been devised to correct delayed gastric emptying. Testing of gastric emptying by the barium burger meal is essential to proper diagnosis. One hundred consecutive patients who required surgery for peptic diseases during the past five years have undergone PPP, the first 20 with, and the next 80 without, vagotomy. Results included two deaths and 94 favorable results. Follow-up studies in these patients continue.