Abstract
From 1971 to 1975, 226 patients received kidney allografts, and prophylactic ulcer surgery was regularly performed prior to kidney transplantation in those who had a history of previous ulcer, symptoms of peptic ulcer, a demonstrable ulcer on x-ray or endoscopy, gastric acid hypersecretion, or a temperament conducive to the development of peptic ulcer. The results of this prophylactic program were compared with those of the previous period from 1964 to 1970 when prophylactic ulcer surgery was not used in 77 kidney allograft recipients, and with those of the concurrent period obtained in 194 recipients who did not receive surgical prophylaxis. Initially, the prophylactic operation was truncal vagotomy with pyloroplasty, then it was proximal selective vagotomy (PSV) without pyloroplasty, and finally it was selective gastric vagotomy with pyloroplasty (SGV+P). The incidence of gastroduodenal complications in patients who did not receive prophylactic ulcer surgery was 22.1% during the period 1964–1970, and 15.9% during the period 1971–1975; the mortality rates from gastroduodenal complications were 10.4% and 4.6%, respectively. In contrast, only 1 of 32 renal transplant recipients who underwent prior prophylactic ulcer surgery developed a gastrointestinal complication, and there were no deaths in the prophylactic surgery group. Two patients developed fatal ischemic necrosis of the stomach following PSV, which led to the adoption of SGV+P as the prophylactic operation of choice.
Résumé
Entre 1971 et 1975, 226 malades ont eu une transplantation rénale. Tous ceux qui avaient des antécédents ou des symptomes d'ulcére gastroduodénal, un ulcère démontré par radiographie ou endoscopie, une hyperacidité gastrique, un tempérament ou un habitus prédisposant à l'ulcère ont subi, avant la transplantation rénale, une chirurgie prophylactique pour ulcère. Les résultats de ce programme préventif ont été comparés à ceux obtenus chez 194 malades qui, pendant la mÊme période, n'ont pas été soumis à une chirurgie gastrique, et aux résultats obtenus au cours de la période précédente (1964–1970), pendant laquelle cette chirurgie prophylactique n'avait pas été appliquée à 77 receveurs. L'opération utilisée a été, d'abord la vagotomie tronculaire avec pyloroplastie, puis la vagotomie sélective proximale sans pyloroplastie (PSV), enfin la vagotomie sélective gastrique avec pyloroplastie (SGV + P). Pour les malades sans chirurgie gastrique prophylactique, la fréquence des complications gastroduodénales a été de 22.1 % pour la période 1964–1970 et de 15.9 % pour la période 1971–1975, avec des mortalités de 10.4 et 4.6 %. Par contre, parmi les 32 malades soumis à une opération prophylactique, il n'y a eu qu'une seule complication gastroduodénale, et aucun décès. Deux malades ont présenté, après PSV, une nécrose ischémique mortelle de la paroi gastrique:c'est pour cette raison que nous avons adopté la SGV+P.
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Uhlschmid, G., Largiadèr, F. Surgical prophylaxis of gastroduodenal complications associated with renal allotransplantation. World J. Surg. 1, 397–403 (1977). https://doi.org/10.1007/BF01556873
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DOI: https://doi.org/10.1007/BF01556873