[Truncal vagotomy in the surgical management of bleeding duodenal ulcer. Report of 50 cases (author's transl)].

To control hemorrhage and eliminate the ulcerogenic mechanism, some surgeons have favored gastric resection and others have preferred the more conservative approach of a vagotomy. The analysis of our 50 cases has shown a high frequency of hemorrhage by arterial erosion. All the patients have been treated by transfixing the ulcer with a local suture, associated with a truncular vagotomy and a gastric drainage, the global mortality rate was 26%. The mortality rate in the group of patients with massive bleeding forcing emergency operation is 33%. No death was observed in the group of patients where bleeding was controlled firstly by non operative measures and operated on later. The patient's chances of survival are markedly improved in the group of younger patients. The analysis of literature have shown that the incidence of rebleeding is the same following vagotomy or partial gastrectomy. The post operative mortality rates after these two types of emergency operative procedures are also quite similar. In conclusion, direct ligation of the ulcer base in massive bleeding, coupled with vagotomy, seems to be the operation of choice.