Clinical Application of the Method of Operations Based on Form and Function

Abstract

The method of operations based on form and function for gastric and duodenal ulcers consists of obligatory selective proximal vagotomy in combination with a nonresecting or minimally resecting procedure on the stomach. Over 80 % of operations can be conducted without resection. If a resection is necessary, it can be kept small (5 to 15 %) provided that SPV was successful according to the standard technique. SPV always precedes the operation on the stomach itself. For duodenal ulcer, the nonresecting procedure is the rule. Only in cases of minimal findings can drainage measures be completely dispensed with, but here, we repeat, one should always ask whether an operation is justified at all. Gastric ulcer can usually be removed by local excision through gastrotomy; in this case malignancy must be considered. It must be borne in mind that the rate of malignant degeneration increases from caudal to cranial, depending on the localization of the ulcer. One avoids the dilemma of whether the operation should be nonresecting or radical by examining the ulcer in toto and sampling the regional lymph nodes intraoperatively by the immediate section method. If the finding is benign, nonresecting procedures are sufficient. If the finding is positive, a radical operation should be carried out.