Effect of Proximal Gastric Resection (Fundectomy) on Gastric Secretion and Motility

Abstract

In proximal resections of the stomach it was observed (Holle and Heinrich, 1954–1960), (fig. 1) that in some 12 % of cases fundectomy leads to the development of gastric ulcers or erosions when combined with bilateral truncal vagotomy. This is the same phenomenon which van Yzeren (1901) and Dragstedt (1943) observed after bilateral truncal vagotomies and which they attributed to the stasis of the gastric contents in a stomach which had become atonic. Analogously with Dragstedt’s experience, we found the gastric ulcer rate to be decreased by 4 % when a drainage operation was added. No gastric ulcers occur when dorsal vagal antrum innervation is maintained in full, the ventral extragastral vagus in the omentum is maintained to the greatest possible extent, and pyloroplasty is performed in addition. This also maintains antral motoricity; emptying is made easier and is effected through the duodenum. When checking the secretion of this model, we found it to be insulin-negative; however, it remains responsive to direct stimulation with histamine (Holle, 1968) and to feeding (unpubl. obs.). The check effected by easuring intragastral pH is not exact, but the effect is easily reproducible. It is most clearly seen when denervation is continued in a distal direction beyond the angulus, i. e. the antrum is also denervated. The acid output, however, remains low as long as the antrum is innervated and drainage is effected. The response of S-Gastrin after feeding is shown in fig. 2. There is a typical feeding curve with a strong immediate maximum response and a relatively short duration of gastrin release (40 min). The curve corresponds to those of functionally efficient SPY and pyloroplasty (p. 78, fig. 1). This means antrum motility is intact. But what else do these findings mean?