Clinical results of 229 patients with duodenal ulcer 1–6 years after highly selective vagotomy

Abstract

The aim of this study was to assess the clinical results after highly selective vagotomy (HSV) when used routinely at a district general hospital. A total of 229 patients with chronic duodenal or prepyloric ulcers was included in a 92 per cent complete follow-up 1-6 years after an elective HSV without drainage. There was no postoperative mortality, and the frequency of postoperative complicatons was low. Transient dysphagia and early fullness each occurred in about a quarter of the patients, whereas persistent dumping was found only in 1.3 per cent and diarrhea in 2.2 per cent of the patients. Recurrent ulcer was diagnosed in 12.7 per cent of the patients, but this figure decreased to 9.3 per cent after exclusion of one of the 24 surgeons involved. The overall clinical results according to the modified Visick classification were recorded as excellent or very good in 70 per cent and unsatisfactory in 20 per cent. The failures were almost exclusively due to a proved or suspected recurrence or to gastric retention, and further operations have been performed on 27 of these patients. After reoperation only 8 patients (3.5 per cent) remained failures according to the patient's own judgement at the time of follow-up. The recurrence ratein this study was considered disquietingly high with regard to the short observation time. However, other obvious advantages of the method and the possibility of improved results after adjustment of the surgical technique were considered to justify continued use of HSV as a routine procedure.

Dynamic Visick grading after highly selective vagotomy

“…If a recurrent ulcer had been demonstrated during that period, the grading was Visick 4, otherwise a grade was given according to the patient's condition. Patients who required reoperation (3 for recurrent ulceration and 2 for stenosis) could applied by some authors [6,[14][15][16]. In the present study, no correction for experience was applied and no patients were excluded.…”

Recurrence rate after highly selective vagotomy

“…In order to improve the results, attempts were ruade to delineate the surgeon failures and, according to many reports, subsequent improvement of technique diminished the number of failures [8][9][10][11][12][13][14][15][16][17][18][19][20]. The supposed completeness of the vagotomy, however, was not always a guarantee against recurrence [21][22][23][24][25][26], so that it should perhaps be postulated that failures inherent in the method do occur after HSV [27][28][29][30].…”

Die selektiv-proximale Vagotomie mit Pyloroplastik beim Gastroduodenalulcus ? Ergebnisse nach 5?9 Jahren

“…In grol3en retrospektiven Serien [1,4,7,9,10,14,15,18] wurden fiber gfinstige klinische Ergebnisse beim unkomplizierten und komplizierten Ulcus duodeni und zum Teil auch beim Ulcus ventriculi berichtet. In prospektiven klinischen Studien konnten nach SPV im Vergleich zur trunculfiren [7] und selektiven Vagotomie [4,5,6,16] gfinstigere Resultate vor allem mit weniger postoperativen Nebeneffekten erzielt werden.…”