[Preoperative analysis of the gastric secretion as guidance for the operative procedure of peptic jejunal ulcers (author's transl)].

The development of a peptic jejunal ulcer after partial gastrectomy may result either from a technical deficiency of the anastomotic region, a seldom-occurring gastrin producing tumor, a displacement of the pyloric antrum into the alkaline milieu of the duodenal stump, an abnormally high vagus tone, or from too low a resection. In 17 out of 32 patients with a peptic jejunal ulcer preoperative gastric secretion analysis were performed during consecutive stimulation of the gastric secretion by gastrin-pentapeptide, histalog, and insulin-induced hypoglycemia. A high basal secretion, which could only be minimally stimulated by exogenous gastrin, required the operative revision of the duodenal stump. A vagotomy was found to be sufficient in patients reacting strongly to hypoglycemia and moderately to gastrin-pentapeptide or histalog. A hypersecretion after stimulation by gastrin-pentapeptide, histalog as well as by hypoglycemia was an indication for a re-resection of the gastric stump. The latter was combined with vagotomy if both the basal and the stimulated secretion values were found to be increased to higher levels. Up to now the postoperative conditions of the patients seem to give support to the procedure applied. It should be possible to reduce the operative letality of the re-resection of peptic jejunal ulcers on the basis of the aforementioned careful selection. Out of the 32 patients of this study only one was lost.