Dissatisfaction attends subtotal gastric resection (70%), even as it continues to be the most widely applied surgical modality in the treatment of duodenal ulcer. This dissatisfaction stems from at least a 15%-20% incidence of unsatisfactory surgical results.5,14,16,21,22,30 As a consequence, surgery is offered to the duodenal ulcer patient often with considerable misgivings and usually only when the complications of perforation, hemorrhage, obstruction, or intractable pain supervene.
The unsatisfactory results of gastric resection have been of two kinds, operative complications and late complications. The operative complications in the main stem from one of the following: difficult dissection of the ulcerated duodenum from its bed when the ulcer is penetrating deeply into the pancreas or dangerously close to the biliary tree; leakage from the duodenal stump when a Billroth II gastroenterostomy is performed or leakage from the anastomoses when a Billroth I gastroduodenostomy is performed. These technical difficulties are responsible for