From Billroth to PCV: a century of gastric surgery.

The development of gastric surgery is one of the most fascinating chapters in surgical history. The first operations on the stomach were done during the second half of the nineteenth century; at first they were minor procedures but then gradually became more daring, major procedures-albeit with considerable mortality. The work of Theodor Billroth and his pupils ushered in the era of major resectional therapy, first for cancer and later also for ulcer disease. Complications due to the lack of understanding gastric physiology plagued the early days of ulcer surgery, and a variety of modifications tried to remedy these problems. Although the role of the vagus was known through Pavlov's studies, its practical application had to wait until well into the twentieth century. For several decades, resection and vagotomy, separately or combined, were practiced until more sophisticated types of vagotomy began to dominate and replace resection in the surgical treatment of ulcer disease. Resection remained the treatment for cancer. We thus see over a period of 100 years, owing to the increased understanding of physiologic factors, a gradual shift from major resections toward smaller, better directed procedures. The pioneering work of Billroth and his generation, however, must not be forgotten.