Five- to Eight-year Results of Truncal Vagotomy and Pyloroplasty for Duodenal Ulcer

Abstract

Of the various postgastric operation syndromes early dumping, late dumping, bilious vomiting, and diarrhoea were all less frequent, but not significantly so, after vagotomy and pyloroplasty than after vagotomy and gastroenterostomy.Recurrent ulceration was commoner after vagotomy and pyloroplasty than after all the other operations, the incidence of proved and suspected recurrent ulcers being respectively 6-7 and 7 3% after vagotomy and pyloroplasty, but only 2 5 and 5-9% after vagotomy and gastroenterostomy, 0 and 5-2% after vagotomy and antrectomy, and 0 9 and 3-7% after subtotal gastrectomy. The differences between vagotomy and pyloroplasty and vagotomy and antrectomy or subtotal gastrectomy are statistically significant, but those between vagotomy and pyloroplasty and vagotomy and gastroenterostomy are not.

Proximal gastric vagotomy without drainage for duodenal ulcer: Results after 5–8 years

“…(For the record, however, it should be mentioned that there was one immediate death from cerebral haemorrhage in the series of 105 women with duodenal uIcer submitted to PGV, and another death from leakage and peritonitis in the group of 80 patients with gastric ulcer-alone or combined with duodenal ulcer-treated by this operation together with excision of the gastric ulcer from inside the stomach through an anterior gastrotomy.) It is the general impression amongst surgeons using PGV that it is a very safe procedure, and a recent postal inquiry by Johnston (1975) (Goligher et al, 1964(Goligher et al, , 1972. In regard to the safety of PGV, one possible hazard is the occurrence of postoperative necrosis of the lesser curve of the stomach.…”

“…In this paper we shall confine our attentions essentially to the results in 316 male duodenal ulcer patients (the other 7 male patients having had the operation being excluded because they had undergone coincidental cholecystectomy) because most of our own well-documented information on the results of other standard surgical procedures for duodenal ulcer, which we intend to use as a yardstick in judging the achievements of proximal gastric vagotomy, relates to male cases (Goligher et al, 1964(Goligher et al, , 1968(Goligher et al, , 1972. Table I: CONDITIONS TREATED BY 544 PROXIMAL GASTRIC VAGOTOMIES WITHOUT DRAINAGE IN THE UNIVERSITY DEPARTMENT OF SURGERY, GENERAL INFIRMARY, LEEDS, 1969-76 INCLUSIVE Non-ulcer dyspepsia including hiatal hernia Gastric ulcer alone Gastric and duodenal ulcer combined Duodenal ulcer alone Female 105 Male 323 Tntal 36 53 27 428 -…”

Effect of Vagus Nerve Injury on the Outcome of Antireflux Surgery: An Extensive Literature Review

“…The functional changes and consequences of this type of injury have not been investigated or evaluated systematically and the clinical consequences remain unclear for that reason. Earlier studies reporting the effect of intended vagotomy on gastric ulcer disease show that vagotomy is accompanied by gastric stasis (nausea 15%, vomiting 4%), diarrhea (20-30%) and dumping syndrome (10%) [15,16,17,18,19]. Latrogenic or accidental VNI during ARS may have effects similar to those after intended vagotomy and therefore, may contribute to newly developed postoperative symptoms and to impaired reflux control after ARS.…”

“…In the clinical setting, no methods are available to directly evaluate vagus nerve (dys)function. The prevalence of VNI after ARS has been estimated in the past based on the onset of newly developed postoperative symptoms associated with VNI such as diarrhea, nausea and vomiting that have been associated with VNI [12,17,18,20]. An objective but indirect method to measure abdominal vagus nerve function is based on the response of plasma pancreatic polypeptide (PP) secretion to insulin-induced hypoglycemia, the IH-PP test or on the response of plasma PP to modified sham feeding, a vagal-cholinergic stimulus [21,22].…”

Pyloroplasty versus gastrojejunostomy: Results of a double-blind, randomized, controlled trial

“…association with truncal vagotomy, Goligher and Pulvertaft (1969) formed the impression that gastroenterostomy gave better overall results, but the cases reviewed were not entirely comparable. In a recently published controlled trial carried out in Glasgow pyloroplasty was compared with gastrojejunostomy in patients having a truncal vagotomy.…”