Revagotomy for recurrent peptic ulceration

Abstract

A review has been made of 59 patients with recurrent peptic ulceration after incomplete vagotomy. Eighteen transthoracic procedures were performed, the remainder having abdominal revagotomy. An antrectomy was also carried out in 10 of these patients. An intact posterior nerve trunk was the most common operative finding and when either an anterior trunk or nerve strands only were present there was less likely to be an early positive insulin response (P = 0.033). Following incomplete vagotomy a longer period of symptomatic relief is obtained when gastro-enterostomy rather than pyloroplasty is used as the drainage (P less than 0.01). Completing the vagotomy by the abdominal route gave superior results to transthoracic revagotomy (P = 0.0015), the former procedure without antrectomy having no associated mortality in this series. Although the results of revagotomy and antrectomy are as good as those of transabdominal revagotomy alone, we recommend the latter more conservative treatment for recurrent ulceration after incomplete vagotomy.

Reoperation for recurrent peptic ulceration

“…While second operations for recurrent ulcer have achieved ulcer heahng in 34 (89 per cent) of our patients 9 (24 per cent) have needed additional procedures, and despite this only 24 (63 per cent) have finally obtained a satisfactory symptomatic result. Our results are similar to those of other workers (6)(7)(8).…”

Management of recurrent peptic ulceration

“…Selection of the appropriate operation may be influenced by the site of recurrence and by the nature of the original procedure. The choice lies between vagotomy or revagotomy alone, using either the abdominal (Taylor et al, 1977) or transthoracic (Hede et al, 1977) route and gastric resection with or without vagotomy (Fawcett et al, 1969).…”

Review of general surgery 1977

“…All cases were converted to good results following re-operation. Taylor, Pearson and Torrance (1977), from Manchester, review their 59 patients with recurrent ulceration following incomplete vagotomy. It was interesting that only 5 of these developed their symptoms 4 years or more after the original operation.…”