Von Haberer-Finney gastrectomy revisited.

Overview

Von Haberer and Finney independently introduced end-to-side gastroduodenostomy for gastrointestinal reconstruction. Clinical appraisal of this procedure with hemigastrectomy is the basis of this report. From 1967 to 1982, 113 duodenal ulcer patients underwent the operation. Indications were intractability in 58 patients, hemorrhage in 36, perforation in two, and obstruction in 17. Truncal vagotomy was performed on all patients except in five with intractability, 19 with hemorrhage, two with perforation, and 17 with obstruction. There were three postoperative deaths (2.7%). Nine patients were lost to follow-up, seven of whom were operated upon 5 or more years previously. Thus far, there has been no clinical evidence of recurrent ulcers or of dumping. Five patients, all chronic alcoholics, were below normal weight. The Von Haberer-Finney gastrectomy has certain distinct advantages: 1) direct inspection of the interior of the descending duodenum is possible during duodenotomy; 2) anatomic continuity of the gastrointestinal tract is established; 3) duodenal stump perforation does not occur because the duodenum can be decompressed via a nasogastric tube passed through the anastomosis; 4) afferent loop syndrome cannot occur; and 5) iron deficiency anemia is less likely because the duodenum is not bypassed.