Late results of proximal gastric vagotomy without drainage for duodenal ulcer: 5–9-year follow-up

Miguel, Jacinto De

doi:10.1002/bjs.1800690104

Cited by 22 publications

(3 citation statements)

References 25 publications

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“…Only one study [14] showed a high recurrence rate of 23% eight years after operation. Compared to long-term results of proximal gastric vagotomy for duodenal ulcer (Table 3), similar recurrence rates are noted [4,[16][17][18][19][20][21][22][23][24][25].…”

Section: Recurrent Peptic Ulcer After Pgv With Ulcer Excisionmentioning

confidence: 79%

Recurrence after proximal gastric vagotomy for gastric, pyloric, and prepyloric ulcers

Heberer

Teichmann

1987

World j. surg.

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Results after proximal gastric vagotomy (PGV) with ulcer excision for gastric ulcer type I (according to Johnson) show recurrence rates similar to those for duodenal ulcer. In the European Multicenter Trial with 71 patients, symptomatic recurrence was 7.9% at 5 years and the total recurrence (including asymptomatic recurrences) was 17.5%. Recurrent ulcers are mainly gastric ulcers. Treatment of recurrence is, initially, always conservative with antacids or H2-receptor blockers. From 19 patients with recurrent ulcer after PGV with ulcer excision for gastric ulcer type I reported from 3 prospective trials, 12 were managed conservatively. The operative procedure of choice for recurrence was partial gastric resection with a Billroth I or Billroth II reconstruction. Favorable results for this type of gastric ulcer after PGV may be explained by maintenance of gastric continence for solids, reduction of duodenogastric reflux and of postoperative gastritis. Preoperatively and intraoperatively, malignancy has to be excluded by multiple biopsies and frozen sections. Combined gastric and duodenal ulcers (gastric ulcer type II) may also he treated by PGV in controlled trials so that more data will be available for that rare type of ulcer. Recurrence rates after PGV for pyloric and prepyioric ulcers (gastric ulcer type III) are significantly higher than those for gastric ulcer type I or duodenal ulcers. After 5 years, recurrence rates of 16.4-35% are reported. This may be due to gastric retention, which is a common feature in patients with prepyloric ulcers. In fact, selective gastric vagotomy and drainage or vagotomy and antrectomy give significantly better results. The operation rate for recurrent ulcers after pyloric and prepyloric ulcers following PGV is about 25% because of pyloric stenosis. It is concluded that PGV and ulcer excision seem to be suitable for gastric ulcer type I and probably for type H. Pyloric and prepyloric ulcers should no longer be treated by PGV alone because of high recurrence rates. A drainage procedure should be added. In general, the operation should be performed by experienced surgeons since recurrence rates depend on the number of surgeons involved in cliulcal trials.It is well established that the only significant postoperative morbidity following proximal gastric vagotomy without pyloroplasty (PGV) for gastroduodenal ulcer disease is ulcer recurrence [1][2][3][4]. Virtually 5 years after PGV, the Visick grade pattern is almost identical with that of blood donors serving as healthy controls [5]. PGV without a drainage procedure was first introduced for treatment of gastric ulcers by Johnston et al. [6]. To evaluate the results of PGV for benign gastric ulcer disease, it is absolutely mandatory to define the type of the

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Section: Recurrent Peptic Ulcer After Pgv With Ulcer Excisionmentioning

confidence: 79%

Recurrence after proximal gastric vagotomy for gastric, pyloric, and prepyloric ulcers

Heberer

Teichmann

1987

World j. surg.

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“…At the present time, parietal cell vagotomy, or proximal gastric vagotomy (PGV), has become an accepted operative method of treating intractable ulcer disease [21]. The operative techniques of PGV have been well described [19] and the results when compared with vagotomy and antrectomy (the most effective anti-ulcer operative technique) have demonstrated a markedly lower postoperative morbidity and mortality but a higher ulcer recurrence rate-approximately 10% [10,27]. This recurrence rate has been disputed, however, since recent studies have shown that with Congo red confirmation staining of the gastric mucosa intraoperatively, the recurrence rate was comparable to vagotomy and antrectomy (1-2%) [11,42].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of benzalkonium chloride chemoneurolytic proximal gastric vagotomy

et al. 1998

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“…Facing the Visick pattern after a given operative procedure, we unconsciously compare it to a healthy population for which we tacitly assume a 100% Visick grade 1 composition. However, results of proximal gastric vagotomy (PGV) without drainage, a procedure praised for its low long-term morbidity and lack of functional sequelae, show an intriguing proportion of symptomatic patients (up to 40% Visick grades 2 to 4) [2][3][4][5][6]. On the other hand, some authors claim a perfect result (Visick 1) in 86% after PGV [7] or even 95% after partial gastrectomy [8].…”

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confidence: 99%

How do clinical results after proximal gastric vagotomy compare with the Visick grade pattern of healthy controls?

et al. 1983

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Recently, the 5‐year results of a multicenter trial on proximal gastric vagotomy (PGV) have been reported. Symptomatic results in 415 duodenal ulcer patients, according to the Visick grading, were as follows: grade 1, 64%; 2, 28%; 3, 4%; and 4, 4%. It appears that one‐third of the patients are symptomatic, and the question arises as to which standard such a Visick grade pattern should be compared. Five hundred sixty‐one healthy controls (blood donors), without history of peptic ulcer or previous gastric operation, have been examined according to a standard questionnaire identical to that used for follow‐up interrogation in the PGV trial. The control group was matched for sex and age with the trial population. Answers to 3 screening questions were compared with the result of detailed interrogation. The control group's Visick pattern was as follows: grade 1, 64.5%; 2, 28.9%; 3, 6.4%; and 4, 0.2%. Symptoms most frequently encountered were those of dyspepsia (pain, epigastric fullness) and gastroesophageal reflux. Dumping (2%) and diarrhea (4%) were also noted. Our conclusions are these: (1) The Visick grade pattern 5 years after PGV is almost identical with that of healthy controls. (2) Dull pain, epigastric fullness, and reflux symptoms are not specific signs after PGV. (3) Screening questions are misleading and follow‐up examinations must be based on a standard questionnaire to provide valid information. (4) The separation between Visick grade 1 and 2 should be abandoned, as it has no clinical importance. (5) PGV has virtually no specific long‐term sequelae except recurrence.

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Late results of proximal gastric vagotomy without drainage for duodenal ulcer: 5–9-year follow-up

Cited by 22 publications

References 25 publications

Recurrence after proximal gastric vagotomy for gastric, pyloric, and prepyloric ulcers

Recurrence after proximal gastric vagotomy for gastric, pyloric, and prepyloric ulcers

Evaluation of benzalkonium chloride chemoneurolytic proximal gastric vagotomy

How do clinical results after proximal gastric vagotomy compare with the Visick grade pattern of healthy controls?

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