[Postoperative recurrent gastroduodenal ulcer: pathogenesis--reinterventions--results].
High 10-year recurrence rates following proximal gastric vagotomy (PGV) for pyloric/prepyloric ulcer (31.6%, European trial) result from antral stasis (Dragstedt-mechanism). Additional pyloroplasty reduces the recurrence rate to 16.6%. General causes of recurrence following PGV are primarily incomplete vagotomy and smoking: For incomplete vagotomy (Burge-test) 24.4% recurrences, for complete vagotomy 13.6% (10-year results); in smokers 38%, non-smokers 12%. Therapy is conservative in 80%. Selective gastric revagotomy and antrectomy as reoperation shows lowest recurrence rate (1.2%). The major cause of recurrence after partial gastrectomy is inadequate resection. Conservative therapy is successful in 76%. Reoperation should be transthoracic vagotomy with no mortality in 11 centers.
Chirurgische Klinik und Poliklinik, Universität München, Klinikum Grosshadern.
R K
RK
Teichmann
C
C
Muller
P
P
Verreet
B
B
Husemann
L
L
Fiedler
B
B
Engelke
D005743:Gastrectomy; D006801:Humans; D010437:Peptic Ulcer / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D014629:Vagotomy, Proximal Gastric
Das postoperative gastroduodenale Rezidivulcus: Pathogenese--Reinterventionen--Ergebnisse.