The aarhus county vagotomy trial

Abstract

In a prospective clinical trial, vagotomy for duodenal ulcer (DU) and prepyloric ulcer (PPU) was performed in 748 patients, 353 of whom were randomly allocated to selective gastric vagotomy and drainage (SGV + D), 54 to SGV + antrectomy (A), 273 to parietal cell vagotomy (PCV), and 68 to PCV + D. By 3 months postoperatively, basal acid secretion (BAO) had not stabilized. During the following year patients with SGV + A showed a decrease, while those with the other operations showed a rise in BAO, significant for SGV + D. One year after operation the level of BAO was the same after the 3 operations that did not remove the antrum. Peak acid output after pentagastrin stimulation (PAOPg) continued to decrease from 3 months to 1 year after SGV + A, while the other operations were followed by an increase, statistically significant for PCV. After 1 year the postoperative reduction in PAOPg was 90% for SGV + A, 45% for PCV, and approximately 60% for SGV + D and PCV + D. Overall clinical grading showed more failures following PCV than after SGV. Since failures after PCV were mainly ulcer recurrences, the final grading (after treatment of the failures) showed an equal number of failures for the 2 operations. Calculation of the probability of ulcer recurrence suggested a 6% rate after SGV + D and an 11% rate after PCV. However, when calculations took into account the location of the primary ulcer, the recurrence rate was the same after SGV + D for DU and PPU, while PCV showed a similar rate when used for DU but an incidence of 22% when used for PPU. The risk of recurrence was found to be constant from month to month during the first 2 1/2 years, after which no new recurrent ulcers were observed. It is suggested that for DU, PCV is preferable to SGV + D because the recurrence rate is the same but the incidence of sequelae is lower. When PCV is used for PPU, a higher ulcer recurrence rate may be expected.

Recurrent Ulcers after Proximal Gastric Vagotomy: Special Aspects of the Prepyloric Ulcer

“…Knight et al [24] observed a 7% incidence of recur rence after PGV in patients with pre-and intrapyloric ulcer, in contrast to the 30% found by Anderson et al [5] and to the results of our study. Contrary to Anderson et al, the previous authors combined the PGV with a drainage operation.…”

“…Because of the imperfection of partial gastrectomy, vagotomy was introduced in the 1940s and today PG V is widely accepted in Europe as the treatment of choice in surgical therapy of chronic duodenal ulcer [1][2][3][5][6][7][8]. This nonrespective procedure leaves the stomach reser voir and the pyloric sphincter intact and has far fewer side effects when compared with other ulcer operations [1][2][3][4][5][6][7][8][10][11][12][13], However, the long-term studies in the late 1970s and early 1980s reported a higher rate of recurrences after PGV than after resection methods [3,5,7].…”

“…An increased recurrence in patients followed up for more than 5-10 years has been reported recently. Apart from an incom plete vagotomy several factors may be responsible for the development of recurrent ulcers after vagotomy since in some studies [5][6][7] but not in all [8] the long term recurrence rate seems to be dependent on the preoperative acid secretion and on the site of the primary ulcer [5][6][7].The aim of the following study was to analyze the recurrence of peptic ulcer in 505 patients after PGV and to determine its dependence on the primary ulcer local ization. …”

A prospective randomized trial of vagotomy in chronic duodenal ulceration

“…There were 13 comparable clinical results but there was significantly more diarrhoea after TVP. Kennedy et al (1975) reported that HSV produced significantly less dumping, nausea and bile vomiting than selective vagotomy and gastrojejunostomy without an increased risk of recurrent ulcer (2 per cent in each group).More recently, Amdrup et al (1977) have compared HSV and selective gastric vagotomy without drainage in a randomized trial in which 267 out of 554 patients were followed up after 2 years. The recurrence rates were 8 per cent in each group and there were similar clinical results, although there was significantly less dumping after HSV.…”

“…More recently, Amdrup et al (1977) have compared HSV and selective gastric vagotomy without drainage in a randomized trial in which 267 out of 554 patients were followed up after 2 years. The recurrence rates were 8 per cent in each group and there were similar clinical results, although there was significantly less dumping after HSV.…”