An assessment of postoperative testing for completeness of vagotomy

Significance of early and late positive responses to insulin hypoglycaemia in patients with intact vagi

“…This suggests that a similar response to insulin after surgery cannot be held to indicate 'adequate' vagotomy. The same inference can be drawn from the 24 % incidence of recurrent ulcers in patients with late insulin responses, reported by Johnston et al (1967). Ross and Kay (1964) found that patients with late responses to insulin after vagotomy had a greater mean reduction in the augmented histamine response compared with preoperative values than did those with early responses.…”

“…Ross and Kay (1964) found that patients with late responses to insulin after vagotomy had a greater mean reduction in the augmented histamine response compared with preoperative values than did those with early responses. Johnston et al (1967) found that the incidence of recurrent ulceration was 68 % in those with early responses but only 24% in the late responders. It was therefore of interest to see whether the gastric secretory patterns of patients with intact vagi who had early insulin responses differed from those in patients with late responses.…”

“…'EARLY' AND 'LATE' RESPONDERS The basal acid concentration and output, the rise in acid concentral tion, peak concentration, and peak output after insulin in the patients with 'early' and 'late' responses to insulin, as defined by Ross and Kay (1964) and by Johnston et al (1967), were compared (Table II). The results may be summarized as follows:…”

“…It was then possible to divide the patients into those showing 'early positive' and 'late positive' responses, using the 45-minute dividing line described by Ross and Kay (1964) and the one-hour division of Johnston et al (1967).…”

Physiological and Clinical Significance of Highly Selective Vagotomy without a Drainage Procedure

“…A pyloroplasty or gastroenterostomy, after all, is performed merely to permit the vagotomized stomach to empty; but if the stomach empties well without a drainage procedure, why should one be used? Antrectomy greatly reduces the incidence of recurrent ulceration after truncal vagotomy with a drainage procedure (but only when the incidence of incomplete vagotomy is high [40,43,49]). If, however, the incidence of recurrent ulceration after HSV rises little above its present level of 0-6%, the argument in favour of adding an antrectomy to vagotomy would lack cogency.…”