Operative technique for recurrent ulcer after vagotmoy and Jaboulay gastroduodenostomy.

Seven patients with ulcer recurrence following primary operation by vagotomy and Jaboulay gastroduodenostomy were treated by methods depending on the site of recurrence. A recurrent ulcer in the stomach was treated with a broad Billroth I reconstruction. In the anterior wall of the duodenum it was necessary to excise the penetrating ulcer cutting throught the bridge to the resection edge in the first part of the duodenum. A solid longitudinal closure is practical provided that the medial collar of the second part of the duodenum is at least 1 cm from pancreas. Recurrent ulcer in the posterior duodenal wall was in one case treated by leaving a collar of the antrum after removing the mucosa. This collar was used to close the gastroduodenostomy. If a large recurrent ulcer involves the second part of the duodenum, as in three of the referred patients, it was necessary to resect not only the duodenal bulb but also the proximal extent of the second part of the duodenum. One patient developed significant postoperative complications following this procedure. We feel that the procedure itself is technically difficult and should be taken account of by all who contemplate introducing gastroduodenostomy as a routine drainage procedure.