Skip to main content
Annals of Surgery logoLink to Annals of Surgery
. 1985 Jun;201(6):684–689. doi: 10.1097/00000658-198506000-00003

Vagotomy plus Bilroth II gastrectomy for the prevention of recurrent alcohol-induced pancreatitis.

H H Stone, R J Mullins, W A Scovill
PMCID: PMC1250793  PMID: 4004381

Abstract

Three retrospective reviews documenting a lessened frequency of acute recurrent alcohol-induced pancreatitis following vagotomy, with or without gastrectomy or gastroenterostomy, prompted a prospective evaluation of truncal vagotomy with Bilroth II gastrectomy as a means of preventing such exacerbations. Randomization between operation and encouragement to abstain from alcohol in patients with a history of more than one, but less than ten, acute bouts of alcohol-induced pancreatitis was set by odd-even digits in the hospital number. Of 176 patients admitted with acute alcoholic pancreatitis during 23 months of study, 49 were excluded because of too few or too many prior attacks. Another 61 refused to enter the study. At least one (average 1.9) recurrence requiring hospitalization was noted in 49, or 80%, of these patients on follow-up for 2 to 26 months (average 14 months). Of the 66 who consented to participate, 33 were randomized not to undergo operation and had almost identical recurrence statistics (i.e., an average of 1.7 recurrences in 24, or 73%). By contrast, only two of 31, or six per cent, allocated to operation have experienced a recurrence (p less than 0.001). Two who had been randomized were excluded because of persisting active pancreatitis.

Full text

PDF
684

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Broe P. J., Zinner M. J., Cameron J. L. A clinical trial of cimetidine in acute pancreatitis. Surg Gynecol Obstet. 1982 Jan;154(1):13–16. [PubMed] [Google Scholar]
  2. Dressel T. D., Goodale R. L., Jr, Zweber B., Borner J. W. The effect of atropine and duct decompression on the evolution of Diazinon-induced acute canine pancreatitis. Ann Surg. 1982 Apr;195(4):424–434. doi: 10.1097/00000658-198204000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. ELLIOTT D. W., WILLIAMS R. D., ZOLLINGER R. M. Alterations in the pancreatic resistance to bile in the pathogenesis of acute pancreatitis. Ann Surg. 1957 Oct;146(4):669–682. doi: 10.1097/00000658-195710000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Fried G. M., Ogden W. D., Zhu X. G., Greeley G. H., Jr, Thompson J. C. Effect of alcohol on the release of cholecystokinin and pancreatic enzyme secretion. Am J Surg. 1984 Jan;147(1):53–57. doi: 10.1016/0002-9610(84)90034-5. [DOI] [PubMed] [Google Scholar]
  5. Glaser B., Vinik A. I., Sive A. A., Floyd J. C., Jr Plasma human pancreatic polypeptide responses to administered secretin: effects of surgical vagotomy, cholinergic blockade, and chronic pancreatitis. J Clin Endocrinol Metab. 1980 Jun;50(6):1094–1099. doi: 10.1210/jcem-50-6-1094. [DOI] [PubMed] [Google Scholar]
  6. KUNE G. A. SURGICAL ANATOMY OF COMMON BILE DUCT. Arch Surg. 1964 Dec;89:995–1004. doi: 10.1001/archsurg.1964.01320060063012. [DOI] [PubMed] [Google Scholar]
  7. Klein E. S., Grateron H., Rudick J., Dreiling D. A. Pancreatic intraductal pressure: I. A consideration of regulatory factors. Am J Gastroenterol. 1983 Aug;78(8):507–509. [PubMed] [Google Scholar]
  8. Klempa I. Erweiterte Indikation zur Vagotomie bei der chirurgischen Therapie der chronischen Pankreatitis. MMW Munch Med Wochenschr. 1979 Sep 28;121(39):1253–1254. [PubMed] [Google Scholar]
  9. LEWIS F. J., WANGENSTEEN O. H. Antibiotics in the treatment of experimental acute hemorrhagic pancreatitis in dogs. Proc Soc Exp Biol Med. 1950 Jun;74(2):453–455. doi: 10.3181/00379727-74-17937. [DOI] [PubMed] [Google Scholar]
  10. McCLEERY R. S., KESTERSON J. E., SCHAFFARZICK W. R. A clinical study of the effect of vagotomy on recurrent acute pancreatitis. Surgery. 1951 Jul;30(1):130–147. [PubMed] [Google Scholar]
  11. Meshkinpour H., Molinari M. D., Gardner L., Berk J. E., Hoehler F. K. Cimetidine in the treatment of acute alcoholic pancreatitis. A randomized, double-blind study. Gastroenterology. 1979 Oct;77(4 Pt 1):687–690. [PubMed] [Google Scholar]
  12. Pradhan D. J., Leveque H., Juanteguy J. M., Seligman A. M. Pancreatitis. The role of vagotomy, antrectomy, and Billroth II gastroenterostomy in the treatment of alcoholic pancreatitis. Am J Surg. 1972 Jul;124(1):21–27. doi: 10.1016/0002-9610(72)90158-4. [DOI] [PubMed] [Google Scholar]
  13. RICHMAN A., COLP R. Chronic relapsing pancreatitis; treatment by subtotal gastrectomy and vagotomy. Ann Surg. 1950 Feb;131(2):145-58, illust. doi: 10.1097/00000658-195002000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. ROUTLEY E. F., MANN F. C., BOLLMAN J. L., GRINDLAY J. H., FLOCK V. Effects of vagotomy on pancreatic secretion. Proc Staff Meet Mayo Clin. 1950 Apr 26;25(9):218–222. [PubMed] [Google Scholar]
  15. SCHAFFARZICK W. R., FERRAN H. H., McCLEERY R. S. A study of the effect of vagotomy on experimental pancreatitis. Surg Gynecol Obstet. 1951 Jul;93(1):9–15. [PubMed] [Google Scholar]
  16. Satiani B., Stone H. H. Predictability of present outcome and future recurrence in acute pancreatitis. Arch Surg. 1979 Jun;114(6):711–716. doi: 10.1001/archsurg.1979.01370300065010. [DOI] [PubMed] [Google Scholar]
  17. Schwartz T. W. Pancreatic polypeptide: a hormone under vagal control. Gastroenterology. 1983 Dec;85(6):1411–1425. [PubMed] [Google Scholar]
  18. Thambugala R. L., Baron J. H. Pancreatic secretion after selective and truncal vagotomy in the dog. Br J Surg. 1971 Nov;58(11):839–844. doi: 10.1002/bjs.1800581111. [DOI] [PubMed] [Google Scholar]
  19. Trunin M. A. Operatsii na vegetativnoi nervnoi sisteme pri lechenii khronicheskogo pankreatita. Sov Med. 1970 Apr;33(4):122–127. [PubMed] [Google Scholar]
  20. WENER J., SIMON M. A., HOFF H. E. Production of acute pancreatitis in dogs by the administration of mecholyl. Gastroenterology. 1950 May;15(1 1):125–130. [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES