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

Abstract

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

Surgical treatment of peptic ulcer disease: current indications and techniques

“…As mentioned above, the addition of partial gastrectomy decreases the rate of ulcer recurrence (6-7, 9%) [23] since by removing the antrum, the number of gastrin-producing cells -as well as some acid-producing parietal cells -is reduced. This technique adds more morbidity and mortality rates, and it is more difficult to perform.…”

29. Das postoperative gastroduodenale Rezidivulcus: Pathogenese - Reinterventionen - Ergebnisse

“…Dann ergeben sich nahezu so gute Ergebnisse wie beim Ulcus duodeni. Diese 10-JahresErgebnisse bestatigen die Daten anderer Autoren (n. [8,16]). Demgegenfiber steht als Erstoperation fiir diesen Ulcustyp die selektiv-gastrale Vagotomie und Antrektomie [4].…”

Role of acid secretory response to sham feeding in predicting recurrent ulceration after proximal gastric vagotomy

“…During follow-up 38 patients claimed that they did not smoke. Of 16 patients who confirmed regular non-steroidal anti-inflammatory drug (NSAID) intake at interview before surgery, 12 continued after PGV.…”