Vagotomy and Pyloroplasty: Advances 1975-1980

ISBN-13: 9783540100836 / Angielski / Miękka / 1980 / 146 str.

F. Holle; G. E. Holle

Opis

The preceding monograph: ''Vagotomy - latest advances," Springer-Verlag, 1974 ed. by F. Holle and S. Andersson reported an innovation in surgery: the so-called "selective proximal vago tomy (spv) with pyloroplasty (pypl)." The usefulness of the method was put to the test in cases of peptic ulcer disease and in dog experiments. No claim was made - as some reviewers erroneously supposed - that the method was a comprehensive presentation of the surgery of peptic ulcer disease or even that it offered a patent solution to this subject Instead, it should be regarded as the initial step towards this goal. The clinical results obtained during the years 1964-74 encouraged us to pursue this line of approach with a view of reaching a stomachpreserving or non-resective method in peptic ulcer surgery and to test the appli cability of the method to other benign disorders of the stomach. After 16 years of testing and experience with over 2000 cases S (Dec. 1t. 1979) of selective proximal vagotomy with pyloroplasty, supplemented by advanced studies on the pathophysiology of the method, an additional volume is now proposed: "Vagotomy and Pyloroplasty, advances 1975-1980," Springer-Verlag 1980. This subsequent volume deals primarily with improvements and findings made during the last 5 years. It also refers to important questions concerning the practical performance of the method which arose from congresses and discussions in this field. These are: 1. Definition, efficiency and effects of the model: spv + pypl. 2."

Spis treści

Contents1.- A: Introduction.- I. Mechanical Versus Functional Surgery.- II. The Beginning of Functional Surgery for Peptic Ulcer.- III. Early Observations on a Functional Method of Surgical Treatment for Peptic Ulcer.- IV. Establishment of Theoretical Model of a Non-resective Method.- B: Patho-physiological Background.- I. Definition and Efficiency of the Model.- 1. Parameters for Checking the Model.- 2. Designation of the Model.- 3. Efficiency of the Model.- II. Effects of the Model.- 1. Effect on Gastric Secretion.- 2. Long-term Effect on Acid Secretion.- 3. Explanation of the Acid-reducing Effect.- 4. Histological Effect on the Fundic Mucosa.- 5. Effect on Blood Circulation.- 6. Effect on Gastrin Release.- 7. Findings still Open to Question.- C: Prerequisites and Technique of Adequate SPV (= a-SPV).- I. Prerequisites for an a-SPV.- 1. Suitable Tests for a Critical Examination of a-SPV.- 2. Technique Which is Both Effective and Durable.- 3. Topographical and Practical Anatomy.- 4. Importance of the “Borderline Nerves”.- 5. Importance of intra-operative Tests.- II. Functional Considerations Regarding Indication and Choice of Procedure.- 1. Procedures Appropriate to Form and Function.- 2. Practical Model for Non-resective Procedure.- 3. Functional “Key” to Procedure.- 4. Diagnostic System Ensuring Reliable Indication.- 5. Choice of Functional Procedure.- III. Standard Technique of Adequate SPV (a-SPV).- D: The Why? and How? of Drainage Within the Non-resective Method.- I. The Deficiencies of a-SPV.- 1. Effect on Acid Secretion and Gastrin Release After Feeding.- 2. Effect on Gastric Motility.- 3. Motility After Step-wise Denervation of the Antrum.- 4. Influence of Motility on the Pathogenesis of Gastric Ulcer (Dragstedt’s Theory).- II. The Importance of the Antro-pyloric Canal.- 1. Significance of Neural and Muscle Coat Changes in the Antro-pyloric Aerea.- 2. Diagnostic Value of Gastrin Measurement.- 3. The Gastrin Profile Test.- 4. Résume of Part D I., II., 1–3.- 5. Significance of the Corpus-antrum Transitional Zone for Acid Reduction.- III. Functional Measurement of the Motility of the Stomach as a Whole (Especially Functional Scintigraphy).- 1. Gastro-duodenal Scintigraphy.- 2. Comparison of X-ray and Scintigraphic Evaluation.- 3. Esophago-gastric Scintigraphy (especially in Hiatal Hernia and Achalasia).- IV. The Meaning of Pyloroplasty appropriate to Form and Function (ff-pypl) and its Standard Techniques.- 1. Submucosal (s.m.) Pyloroplasty.- 2. Open Pyloroplasty.- 3. Pylorectomy.- 4. Retrocolic Posterior Gastro-enterostomy as a Way Out.- E: Results: Short Review of Experiences with the Non-resective Method in 2072 Cases.- I Clinical and Experimental Examinations on the Efficiency of a ff-Pyloroplasty.- II Effect of Different Pyloroplasties on Functional Results.- III Clinical Results of the Munich Series Compared to Other Studies.- IV Summary of Present Non-resective Surgery for Primary Peptic Ulcer.- F: Indication, Application and Results of the Method in Cases Other Than Primary Peptic Ulcer.- I. Complicated Ulcer.- 1. Perforated Ulcer.- 2. Bleeding Ulcer.- 3. Functional Indication and Choice of Procedure in Recurrent Ulcer.- II. Achalasia, Hiatal Hernia and other Indications.- 1. Method in Achalasia of Cardia.- 2. Method in Hiatal Hernia.- 3. Other Indications Under Discussion (Hypersecretion, Dyspepsia, Gastritis, Prophylactic Application).- III. Appendix.- 1. Indication in Cases of Concomitant Psychosyndrome.- 2. How to Advise the Patient on His Post-operative Way of Life (Leaflet).- References.