Recurrent Ulcers after Proximal Gastric Vagotomy: Special Aspects of the Prepyloric Ulcer

Abstract

In a prospective study we analyzed the recurrence rates in 505 patients with a chronic duodenal, intrapyloric or prepyloric ulcer. In the period from 1973 to 1982 the 5-year recurrence rate in 392 patients after proximal gastric vagatomy was 10% for the intrapyloric and 14.5 % for the duodenal ulcer, whereas patients with a prepyloric ulcer had a recurrence rate of 29%. Since 1982 our therapy of choice for the prepyloric ulcer has therefore been antrectomy and selective gastric vagotomy. The recurrence rate in 19 patients with a prepyloric ulcer treated by this procedure was now 0%. Furthermore we analyzed and discussed acid and gastrin secretion in this group of patients in relation to the different ulcer localizations.

Indication and Surgical Therapy in Uncomplicated Peptic Ulcer Disease

“…The therapy in these albeit not very common cases would consist in antrectomy, since this is the only way to abolish the causative agent: the G cells. A PGV will always lead to recurrences, since the procedure as such induces postoperative hypergastrinemia [33],…”

“…The further refinements of the vagotomy proce dures leading to the introduction of the proximal gastric vagotomy (PGV) have relegated the methods of gastric surgery involving resections to a secondary place. How ever, there are certain cases of ulcers such as gastric ulcers in which the long-term results of vagotomy do not fulfill the expectations [28,33]. As a consequence, it has been realized in recent years that peptic lesions require a differentiated pathophysiological analysis which then leads to a differentiated choice of surgical treatment from the spectrum available.…”

“…4). The reason for this is most probably the therapeutic fail ure of vagotomy in certain types of ulcers such as gastric ulcers [28,33,34,37], (4) The main reason for surgical therapy is to prevent duodenal ulcers from recurring.…”