During a 7-year period proximal gastric vagotomy (PGV) was performed in 565 patients. Of these, 210 patients with duodenal ulcer and 14 with dyspepsia without demonstrable ulcer at the time of operation were followed for 5--7 years. Sixty-six percent are symptom-free (Visick I), 23% have no complaints when they take certain dietary measures (Visick II), 3% are improved but still have periods of dyspepsia (Visick III), and 8% are failures because of recurrent ulcer (Visick IV). There were 4 duodenal, 3 pyloric, 5 prepyloric, and 7 lesser-curve gastric recurrences. There were one operative death (0.2%) and one major complication (0.2%). The side effects after PGV are mild, infrequent, and seldom of any significance to the patients. Diarrhoea and dumping are virtually eliminated. Body weight was stable during the whole period of study, and blood chemistry did not disclose any deficiency in haemoglobin, serum iron, or vitamin B12 which might be attributed to PGV. It is concluded that 5--7 years after proximal gastric vagotomy for duodenal ulcer there is a 10% recurrence rate, but the low risk of death and of severe complications and the lack of significant side effects more than outweight the high recurrence rate.

Proximal gastric vagotomy has been performed in 605 patients. Ulcer recurrence occurred in 59 (9.8%) and the relationship of recurrent ulceration to age, sex, gastric emptying time, and gastric acid secretion has been examined. The recurrence rate in 428 of the patients followed for more than 5 years was 11.4%. There was no significant difference in recurrence rates between men and women. Less than half of the recurrences were located in the duodenal bulb (40%). No significant difference in gastric emptying time was found between patients with and without recurrence. The results of the 3 gastric secretion tests—basal acid output (BAO), maximal acid output (MAO), and the insulin test—showed that patients with ulcer recurrence in the duodenal bulb, both pre‐ and postoperatively, had significantly higher mean values of acid secretion than the other patients with recurrence and the control group without recurrence. At the time of recurrence, the mean values of acid secretion in patients with duodenal recurrence were significantly higher than in the control group, and the insulin test was Hollander positive in 87% of the patients. The acid secretion in patients with pyloric, prepyloric, and gastric recurrence was not significantly different from the control group. The results suggest that an incomplete vagotomy is an important factor in the development of ulcer recurrence in the duodenal bulb. Recurrences confined to the stomach, however, seem to develop in spite of an adequate vagotomy and no causal factor could be discovered in these patients.

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Between 1970 and 1983, seventy‐eight patients with duodenal ulcer and pyloric stenosis causing gastric outlet obstruction have been operated on with a proximal gastric vagotomy (PGV) and a Heineke‐Mikulicz pyloroplasty. The mean observation time was 90 months. There was no operative mortality or major complications. The reduction in mean acid output was greater after PGV and pyloroplasty than after PGV without drainage in patients with duodenal ulcer without stenosis. The clinical results were excellent or good in 93% of the patients (Visick I and II). Only 1 patient (1.3%) developed a recurrent ulcer, while 5 patients (6.4%) had symptoms of slight or moderate dumping.It is concluded that PGV and pyloroplasty is a good operation in patients with duodenal ulcer and pyloric stenosis. There is a low incidence of ulcer recurrence, a low risk of serious complications, and good long‐term symptom control.

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