Change of gastric liquid emptying after highly selective vagotomy and pyloric dilatation for patients with obstructing duodenal ulcer

Abstract

Gastric liquid emptying was studied in duodenal ulcer patients with and without stenosis before highly selective vagotomy (HSV) and 1 week, 3 months, and 1 year after. The test meal consisted of 1 mCi of 99m Technetium-diethylene penta-acetic acid (DTPA) in 500 ml of isotonic saline. The patients were divided into 2 groups: group 1 (16 cases) without clinical stenosis, who underwent HSV alone, served as control; group 2 (14 cases) with mild to moderate stenosis, who underwent HSV and transgastric dilatation to 20 mm in diameter. Before HSV, the stenotic group showed a significantly slower liquid emptying than the nonstenotic. Most of the stenotic group could resume a normal diet quickly after operation, but they still had prolonged liquid emptying. At 3 months, the emptying curve of the stenotic patients had approached that of the preoperative controls without a significant difference, while the nonstenotic patients showed an accelerated initial emptying. Although there was a significant improvement with the appearance of accelerated initial emptying at 1 year, the stenotic group still demonstrated slightly slower emptying than the nonstenotic group. A temporary state of preexistent gastric atony due to chronic outlet obstruction may explain the delayed emptying in the early postoperative period; however, minor residual resistance in the fibrotic, scarred tissue was postulated to be persistent despite dilatation, and responsible for the slower emptying of the stenotic than the nonstenotic group at 1 year.

Solid Gastric Emptying after Highly Selective Vagotomy and Pyloroplasty in Patients with Obstructing Duodenal Ulcer

“…12 -17 Previous studies on gastric emptying kinetics after HSV and combined procedures in patients with gastric outlet N Ozalp, MM Ozmen, B Zulfikaroglu et al Solid gastric emptying after highly selective vagotomy obstruction have produced conflicting results, due to differences in surgical techniques and tests used for assessment. 4,5,10,12,13,18,19 Following HSV, vagal innervation of the fundus is impaired, the intragastric pressure is increased and the emptying rate of liquids is accelerated. HSV preserves the antral innervation, so a solid gastric emptying test should be more accurate in evaluating the effects of drainage procedures.…”

“…It was consumed with 200 ml of milk within 10 min. 12,13 Once the meal was finished, gastric emptying scintigraphic studies were performed in a supine position using a gamma camera (SPX-6, Elscint, Hafia, Israel). Using anterior and posterior positions, data from the solid phase studies was acquired for 30 s per frame, at 5-min intervals, for a total of 90 min.…”

Vagotomy During Hiatal Hernia Repair: A Benign Esophageal Lengthening Procedure

“…[28][29][30][31][32][33][34] In contrast, studies have shown that parietal cell vagotomy or highly selective vagotomy during Nissen fundoplication is not associated with increased side effects, morbidity, or mortality. [35][36][37] It may be that the difference in outcome may be attributed to the underlying disease rather than to the vagotomy.…”

Effects of highly selective vagotomy and additional procedures on gastric emptying in patients with obstructing duodenal ulcer

“…It can be improved only by effective drainage. During the past 3 years HSV + D was rarely done in our patients because of the high incidence of delayed gastric emptying and poor clinical results [17].…”

“…During earlier years, the choice of dilatation was usually limited to mild fibrotic stenosis in order to avoid a duodenal rupture, and Jaboulay gastroduodenostomy was restricted to severe fibrotic stenosis where dilatation or pyloroplasty would be technically difficult. Dilatation was rarely done in our patients over the past 3 years, however, because of its poor results [17], and the use of Jaboulay gastroduodenostomy has not been restricted to severe fibrous stenosis.…”