A Polya-type gastrectomy is used when a vagotomy has been used to treat duodenal ulceration - the treatment of choice in this condition - but there has been a recurrence, and the patient has exceptionally high levels of acid secretion.
Firstly, this procedure involves mobilization and resection of the distal two-thirds of the stomach in the same manner as a Bilroth II operation. A hole is made in an avascular part of the mesocolon behind the stomach. A proximal loop of unopened jejunum is then drawn through this hole and anastomosed to the gastric remnant. A posterior seromuscular continuous catgut suture is used. A valve-type mechanism may be inserted to protect the suture line of the stomach at this point: the stomach is divided above the juncture and sutured together in all but one point - a stoma which is then sutured to an incision made into the jejunum.
The cut end of the duodenum is closed, often leaving the ulcer to heal in situ. The gastrojejunal anastomosis is brought down beneath the mesocolon and secured by sutures from the anterior mesocolon to the wall of the stomach.
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