One Thousand One Hundred and Fifty Proximal Gastric Vagotomies for Duodenal and Related Gastric Ulcer

Narbona, B; Dávila, David; Villalba, R; Lloris, J.M.; Narbona-Calvo, Benjamin

doi:10.1159/000171786

Cited by 4 publications

(3 citation statements)

References 3 publications

(8 reference statements)

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“…To take advantage of HSV in the treatment of obstructing DU, duodenoplasty or a drainage procedure such as pyloroplasty and gastrojejunostomy may be a better alternative than dilatation, even in cases with a mild stenosis [15][16][17][18].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 1991

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 1991

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“…Table 1. Retrospective study (1,150 PGVs, duodenal recurrence, or persistence of DU after PGV) [6] Number/recurrence % PGV + pH > 6.4 519/2 0.4 PGV + pH < 6.5 174/4 2.4 PGV 'alone' 282/14 5.2…”

Section: Methodsmentioning

confidence: 99%

“…Finally, in October 1976. monitored experiments [5] made it possible to establish a value of 6.5 as the minimum pH defining complete denervation of an area of gastric mucosa. The results obtained on following these criteria were very good (ta ble 1): of 519 PGVs presenting a pH over 6.4 at five monitoring points [5], only two relapses occurred (85% follow-up) (6). Our experience stressed the existence of two particularly difficult areas: a well-known upper re- gion that responds at pH 6.5-7 following extensive cardiolysis [7] and 'fundus-hiatolysis', and a preantral re gion ( fig.…”

Section: Introductionmentioning

confidence: 93%

Complete Proximal Gastric Vagotomy following Gastroepiploic Nerve Section

Narbona¹,

Olavarrieta²,

Lloris³

et al. 1989

Dig Surg

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Proximal gastric vagotomy (PGV) is the operation of choice in duodenal ulcer (DU), in view of its minimal morbidity-mortality. We discuss the number of recurrences (R) involved in this technique; most are the result of insufficient denervation, whereas a few ‘new gastric ulcers’ are due to emptying problems. Only 1 year after our first PGV (1970), we attempted the incorporation of postoperative tests (pH of gastric juice samples) peroperatively. Later it became possible to situate the electrode on the gastric mucosa after passing it down the esophagus. Finally, the electrode was pressed against the mucosa, and a minimum pH of 6.4 was found to define complete denervation. By this criterion, only two Rs (0.4%) were observed in 519 PGVs. An area resisting pH rise was established: in one fifth of cases the preantral region only rises to pH 7 after gastroepiploic nerve sectioning. We carried out a prospective randomized study of PGV + sectioning of the gastroepiploic nerve (Sge), PGV + pH test and PGV alone. The study involved 293 cases (1980), including 269 followed up for an average of 57 months; Rs were observed in 1.4, 1.7 and 10.1% of cases with the first, second and third method, respectively. In our opinion, PGV + Sge with cardiohiatofundolysis may reduce R to under 4 %.

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

et al. 1994

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A solid gastric emptying study was conducted on 46 patients more than 1 year after highly selective vagotomy (HSV) and additional procedures for obstructing duodenal ulcer and on 21 patients after HSV alone for uncomplicated duodenal ulcer. The additional procedures included dilatation (n = 14; HSV + D group), Holle pyloroplasty (n = 14; HSV + P group), and Jaboulay gastroduodenostomy (n = 18; HSV + GD group). The test meal consisted of two eggs labeled with 99mTc sulfur colloid, two slices of white bread toast, and 300 ml of orange juice (total 322 kcal). Gastric emptying curves and emptying parameters (t1/2, half emptying time; lag phase, TLAG; emptying rate, k; and beta value) were compared with those of 17 healthy volunteers, the normal control group. The patients after HSV alone had an almost normal gastric emptying. The HSV + D group showed a significant delay from minute 45 to the end of the emptying curve, corresponding to a longer t1/2 (p = 0.02), and a slower emptying rate (p = 0.029). The HSV + P group approached a nearly normal emptying curve, corresponding to an insignificant difference in emptying parameters. The HSV + GD group had significantly faster emptying from minute 15 to the end of the emptying curve, corresponding to a faster t1/2 (p = 0.0005), a shorter lag phase (p = 0.027), and a faster emptying rate (p = 0.021). Recurrent ulcerations were noted in one patient (4.8%) of the HSV alone group, five (35.7%) of the HSV + D group, one (7.1%) of the HSV + P group, and one (5.6%) of the HSV + GD group.(ABSTRACT TRUNCATED AT 250 WORDS)

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One Thousand One Hundred and Fifty Proximal Gastric Vagotomies for Duodenal and Related Gastric Ulcer

Cited by 4 publications

References 3 publications

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

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

Complete Proximal Gastric Vagotomy following Gastroepiploic Nerve Section

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

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