Finsterer-Bancroft operation: an option for the treatment of difficult duodenal ulcers

Abstract

Background: In the surgical management of duodenal ulcers, the most feared complications are related to the treatment of the duodenal stump after Billroth lI-type gastric resections. Such complications are more evident in so-called 'difficult duodenum' cases, whose identification is directly related to the surgeon's experience. Among available techniques to avoid those complications, one is the treatment of the antralduodenal stump by the method of pre-pyloric exclusion and removal of antral mucosa, as proposed by Finsterer in 1918 and diffused by Bancroft in 1932. This method, however, was criticized, especially because of the possibility of retaining residual antral mucosa, which would be a determinant factor for the ulcer disease recurrence. The objective of the study was to verify whether the Finsterer-Bancroft operation is a valid alternative in the treatment of unresectable duodenal ulcers, as well as to encourage its application by less experienced surgeons, by the standardization of the surgical technique.

Methods: From April, 1984 to December, 1996 two hundred and six elective partial gastrectomies for duodenal ulcers were performed with Billroth II reconstruction. Of these, in thirty-one (15%), the Finsterer-Bancroft method was used. The patients' ages, varied between 23 and 65 years, constituting 25 males and 6 females. In all cases, surgery was indicated due to the presence of stenosis.

Results: Three patients (9.7%) had complications. There was one death (3.2%) due to leakage of duodenal stump and peritonitis, one case of duodenal fistula (3.2%), and one case of ulcer recurrence (3.2%). All three complications were caused by inappropriate application of the method.

Conclusions: We conclude that the Finsterer-Bancroft operation is a valid alternative in the surgical treatment of chronic duodenal ulcers, when considered unresectable, and is within the reach of in-training and less experienced surgeons.