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The "Combined" Operation for Peptic Ulcer

HENRY N. HARKINS, M.D.; JOHN E. JESSEPH, M.D.; JOHN K. STEVENSON, M.D.; LLOYD M. NYHUS, M.D.
AMA Arch Surg. 1960;80(5):743-752. doi:10.1001/archsurg.1960.01290220035006.
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In 1953 we published the early results of a "combined" operation for peptic ulcer, comprising partial distal gastrectomy (antrectomy), vagotomy, and gastroduodenal (Billroth I) reconstruction.11 Since that time, our experience in the application of this operation has enlarged, and we are now able to provide data on a group of 137 patients treated by this operation, some of whom have been followed for eight years.

An increasing number of centers have adopted partial distal gastrectomy and vagotomy as the operation of choice for the treatment of complicated or chronic duodenal ulceration, and their published reports lend ever-increasing support to its worth.1,5,7,8, 12-14 The concepts upon which this operation is founded are of both experimental and clinical origin. The importance of the antral and the cephalic phases of gastric acid secretion has been shown experimentally by many investigators, and their laboratory findings have been corroborated by clinical experience.2,3,4,13,15,17,18,20

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