Prospective randomized multicentre trial of proximal gastric vagotomy or truncal vagotomy and antrectomy for chronic duodenal ulcer: Interim results

Abstract

In three centres, 222 patients (Birmingham 70, London 87 and Rotterdam 65 patients) with chronic duodenal ulcer were treated by proximal gastrict vagotomy (PGV) (116 patients) or truncal vagotomy and antrectomy (TVA) (106 patients) in a prospective randomized trial. After 1 year 5 recurrent duodenal ulcers (4.3 per cent) have been recorded in the PGV group, compared with 1 (1 per cent) in the TVA group. The reoperation rate was high in both groups-6 after PGV, usually for recurrent ulcer, and 7 after TVA, mostly for gastric retention. PGV showed a marked superiority in the number of patients with a good clinical result Visick I or II) at 1 year after operation, i.e. 82 per cent compared with 56 per cent for TVA.

Lesser curve superficial seromyotomy—An operation for chronic duodenal ulcer

“…By 1975 Johnston reported only 17 deaths following 5539 operations carried out in Britain, Scandinavia and the United States, an operative mortality of 0-3 per cent. The rate of recurrent ulceration, in those series with longer follow-up, has been reported at 4.3 per cent by Goligher et al (1978) and Dorricott et al (1978) and 5.4 per cent by Stoddard et al (1978), incidences similar to that following truncal vagotomy and drainage. However, highly selective vagotomy is not without its disadvantages, namely that the operation is tedious and time-consuming to perform, damage to the nerve of Latarjet may produce gastric stasis and there is a small risk of ischaemic necrosis which, when it does occur, is not uncommonly fatal (Newcornbe, 1973;Hall et al, 1974;Wyllie, 1974;Halvorsen, 1975).…”

“…A small hole in the anterior lesser curvature was oversewn and was considered to be due to a diathermy burn. This hazard is avoidable and al., 1975; Kronborg and Masden, 1975;Dorricott et al, 1978).…”

Pancreatic Secretion after Anterior Gastric Wall Stapling with Posterior Truncal Vagotomy in Dogs

“…Nevertheless, weight gain of the pancreas has also been observed after truncal vagotomy [26], possibly due to hypergastrinemia or gas tric stasis [27] without major changes in pan creatic enzyme secretion. Highly selective va gotomy on the other hand is expected to leave the pancreatic innervation unaltered [28], However, an increased pancreatic sensitivity to secretin stimulation and to a decreased pancreatic capacity has been reported [13], Nevertheless, clinical results suggest that diar rhea (possibly due to pancreatic dysfunction) after highly selective vagotomy is absent [29][30][31].…”

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

“…Favourable reports of HSV for the elective treatment of chronic duodenal ulceration have come from consecutive series of patients undergoing HSV (Humphrey et al, 1972;Amdrup et al, 1974;Hallenbeck et al, 1976;Holst-Christensen et al, 1977;Goligher et al, 1978) and from prospective clinical trials comparing HSV with selective vagotomy and either pyloroplasty (Kronborg and Madsen, 1975) or gastrojejunostomy (Kennedy et al, 1975) and more recently, with truncal vagotomy and antrectomy (Dorricott et al, 1978).…”