Dynamic Visick grading after highly selective vagotomy

Highly selective vagotomy for duodenal ulcer was performed on 307 patients between 1973 and 1983 without operative mortality. Of these, 283 (92.2 per cent) were followed up prospectively for a minimum of 5 years. Recurrent ulcer was diagnosed in 49 (17.3 per cent). The recurrent ulcer rate increased from 13.2 per cent at 5 years to 19.4 per cent at 12 years. Age, length of history, previous haemorrhage or perforation and preoperative acid output were not associated with increased risk of recurrent ulceration. The risk in men and smokers was higher but not significantly so. The recurrence rate for individual surgeons varied from 5.3 to 25.6 per cent. Failure of healing with H2-receptor antagonists was not associated with a higher recurrent ulcer rate. Patients with a strong family history (more than one first degree relative affected) had a significantly higher recurrence rate (33.2 per cent at 10 years) than those without (13.5 per cent at 10 years). Of the 49 recurrent ulcer patients, 30 (61.2 per cent) required either an operation or regular H2-receptor antagonists. Of the 250 patients (81.4 per cent) available in 1988 for review of symptoms 5-15 years after operation, 5.4 per cent had dumping, 8.9 per cent epigastric pain, and 11.8 per cent heartburn every day or most days. H2-receptor antagonists were required by 10.7 per cent of patients on a frequent or regular basis. Of 239 patients who answered the question, 218 (91.2 per cent) felt that their symptoms had been cured or greatly improved and 203 (84.9) considered the operation a success. Despite the high recurrence rate, the operation was successful in controlling ulcer symptoms in around 90 per cent of patients and produced postvagotomy symptoms--none severe--in around 5 per cent of patients.

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Highly selective vagotomy 5–15 years on

Macintyre

Millar

Smith

et al. 1990

Journal of British Surgery

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Results of surgery for duodenal ulcer: Assessment by patients

Stanton

Anderson

1991

Journal of British Surgery

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A questionnaire was administered to 224 patients who had undergone 246 operations for duodenal ulcer to see how well this correlated with Visick grading and to provide insight into the patients' feelings about the results of their surgery. The patients were divided into three groups by Visick grade: good (grade I, n = 70), satisfactory (grades II and IIIs, n = 104) and poor (grades IIIu and IV, n = 72). The distribution of questionnaire responses in each group was statistically different (P less than 0.01). Dividing the questionnaire responses into three corresponding groups, 72 per cent of patients assigned themselves to the same group as their Visick grade. Three observations were made regarding the Visick system: recurrent ulceration is over-scored and should be included only if symptomatic; grading should acknowledge a wider range of symptoms related to ulcer disease and its treatment; only three grades are necessary.

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Dynamic Visick grading after highly selective vagotomy

Cited by 2 publications

References 20 publications

Highly selective vagotomy 5–15 years on

Highly selective vagotomy 5–15 years on

Results of surgery for duodenal ulcer: Assessment by patients

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