Highly selective vagotomy or truncal vagotomy and pyloroplasty for chronic duodenal ulceration: A randomized, prospective clinical study

Abstract

The results of a randomized, prospective clinical trial of highly selective vagotomy (HSV) versus truncal vagotomy and pyloroplasty (TVP) in 126 male patients undergoing elective surgery for chronic duodenal ulceration are presented. The operations were performed by surgeons of all grades of experience. At a mean follow-up time of just over 3 years a satisfactory result was obtained in 93 per cent of patients following HSV and 78 per cent of patients following TVP, the difference being probably statistically significant (P less than 0.05). The incidence of early and late dumping, bile vomiting, flatulence, post-prandial epigastric discomfort and wound infection was statistically significantly less after HSV than after TVP. Three patients have developed a recurrent duodenal ulcer after each type of operation (5.4 per cent). At this early stage HSV has advantages over TVP; it will be interesting to see if these are maintained with the passage of time.

Comparison of the Effect of Conventional Highly Selective Vagotomy and Anterior Gastric Wall Stapling with Posterior Truncal Vagotomy on the Gastric Emptying Rate for Solid Meals in Beagle Dogs

“…Ulcer recurrence seems comparable to that following other types of vagotomy [19,21,31]. Antral motility is unaffected and sequelae due to a drainage procedure are 29] so that the selectivity of vagotomy can be restricted to the anterior side of the stomach.…”

Review of general surgery 1978

“…Now that long-term results are well established in both groups, it is obvious that in competent hands, good results are obtained by both operations (Stoddard, Vassilakis and Duthie, 1978). The highly selective vagotomy has the advantage of a very low incidence of the dumping syndrome and of diarrhoea but is accompanied by an increased risk of recurrent ulceration.…”

Experimentelle Untersuchungen zum Einflu� der Pyloroplastik und der Pylorusstenose auf die motorische und sekretorische Magenfunktion bei der selektiv-proximalen Vagotomie

“…Im Vergleich zu anderen Vagotomieformen sind postoperative Diarrhoe, Dumping und Erbrechen geringer [3,15,20,31]. Sowohl niedrige als auch hohe Rezidivraten in Abh/ingigkeit vonder durchgefiihrten Operationstechnik, vom Operateur und vom zeitlichen Abstand nach der Vagotomie wurden beobachtet [4,15,22,31]. Durch das Auftreten von postprandialem V611egefiihl mit antraler Stase [3,19] und Ulcusrezidiven in Form von Ulcera ventriculi [15,34] stellt sich die Frage, ob die Magenentleerung nach alleiniger SPV trotz erhaltener Antrumfunktion gest6rt ist.…”

“…Bis zu 27 ~o der operierten Ulcus duodeni-Patienten weisen eine Stenose auf [2,25,31]. In 6 ~ soil eine schwere Stenose bestehen [31].…”