Antrectomy

Antrectomy, also called distal gastrectomy, is a type of gastric resection surgery that involves the removal of the stomach antrum to treat gastric diseases causing the damage, bleeding, or blockage of the stomach. This is performed using either the Billroth I (BI) or Billroth II (BII) reconstruction method. Quite often, antrectomy is used alongside vagotomy to maximise its safety and effectiveness. Modern antrectomies typically have a high success rate and low mortality rate, but the exact numbers depend on the specific conditions being treated. The history of antrectomy traces back to the 19th century, starting with the first successful gastric resection in 1810. Since then, antrectomy has undergone a magnitude of changes, where development in the field continues to this day. Even though antrectomy paired with vagotomy and anastomosis is now the established gold standard, its side effects and clinical relevance remains a controversial subject. With advancements in alternative surgeries and other non-invasive treatments, antrectomy is less common nowadays.

Antrectomy, also called distal gastrectomy, is a type of gastric resection surgery that involves the removal of the stomach antrum to treat gastric diseases causing the damage, bleeding, or blockage of the stomach. This is performed using either the Billroth I (BI) or Billroth II (BII) reconstruction method. Quite often, antrectomy is used alongside vagotomy to maximise its safety and effectiveness. Modern antrectomies typically have a high success rate and low mortality rate, but the exact numbers depend on the specific conditions being treated. The history of antrectomy traces back to the 19th century, starting with the first successful gastric resection in 1810. Since then, antrectomy has undergone a magnitude of changes, where development in the field continues to this day. Even though antrectomy paired with vagotomy and anastomosis is now the established gold standard, its side effects and clinical relevance remains a controversial subject. With advancements in alternative surgeries and other non-invasive treatments, antrectomy is less common nowadays. Following the success of the first gastric resection, the birth of antrectomy is attributed to a better understanding of the gastrointestinal system in the early 20th century. Upon the discovery of gastrin by John S. Edkins in 1906, E. Klein published the first report combining vagotomy with gastrectomy to ease symptoms of excessive gastric juice secretion. By 1946, American physicians Farmer and Smithwick performed the first vagotomy with hemigastrectomy (the removal of one-half of the stomach). In the following year, Herrington of Vanderbilt University similarly combined vagotomy with the removal of the lower stomach to improve operational effectiveness, sparking the earliest resemblance to the antrectomy performed today. During the same period, other variations of Billroth's gastrectomy such as concurrent gastrojejunal anastomosis were also transforming the landscape of gastrectomy, with the most notable contributions by surgeons Hofmeister, Polya, von Haberer, and Finsterer. These variations influenced the way antrectomy is practiced, specifically the type of surgeries that antrectomy is paired with. In the subsequent decades, antrectomy continued to evolve with advancements in surgical techniques. The 1950s marked the popularization of diagnostic and operational laparoscopy in hospitals and medical training. This meant that antrectomy could be performed in a minimally invasive manner. However, complications such as diarrhea in antrectomy continue to be a problem, with a 1952 edition of The Lancet Review commenting, 'fashions in the treatment of peptic ulcer come and go, and the surgical problem remains unsolved.' Hence the 1950s and 60s also marked the era of comparative studies of stomach surgery in an attempt of finding an effective method with the least side effects. Most notably, the 1968 Leads-York controlled trial published by The British Medical Journal found that the combination of vagotomy and gastrectomy is superior to other forms of surgery such as gastroenterostomy on the Visick grading (scoring system to quantify the symptomatic outcome of peptic ulcer surgery). The decades leading up to the present featured shifting applications of antrectomy. With the commercialization of acid-reducing medications such as antacids in the late 1970s, the incidence and prevalence of gastric ulcers fell, hence reducing the need for antrectomy. At the same time, British physician David Cowley became the first person to diagnose and treat pseudo-Zollinger-Ellison syndromes (stomach ulceration and excessive gastric acid production) using antrectomy and vagotomy. In the subsequent decades, a better understanding of the Zollinger-Ellison syndrome led to antrectomy becoming one of the key treatment methods for the ailment. Despite this, advent of newer non-invasive methods of resolving gastric disorders have made antrectomy less relevant nowadays. By 2003, antrectomy is no longer recognized as the first-line treatment for gastric antral vascular ectasia (watermelon stomach) and peptic ulcer disease.

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