The Aarhus County Vagotomy Trial: Trends in the problem of recurrent ulcer after parietal cell vagotomy and selective gastric vagotomy with drainage

Abstract

In a prospective, randomized study, 691 patients with duodenal (DU), pyioric (PU), or prepyloric (PPU) ulcers have been followed for 2-5 years after operation with parietal cell vagotomy (PCV) or selective gastric vagotomy with drainage (SGV + D). About half the patients have been followed for 5 years. Cumulative 5-year recurrence rates, calculated by a life table method, suggest a higher recurrence rate for patients with DU when operated with PCV (15%) than when operated with SGV + D (9%), but the difference was not statistically significant (p > 0.05). Patients with PU/PPU had higher recurrence rates following either procedure than patients with DU (PCV: 33%; SGV + D: 14%).A study of the change in recurrence risk as a function of time after operation suggests that the recurrence rate following SGV + D when used for DU will continue to rise after 5 years, but probably very slowly. The recurrence rate after 5 years is unpredictable, however, for PCV when used for DU, and unpredictable for both methods when used for PU/PPU.The recurrence rate was found to be independent of the level of preoperative gastric acid secretion, and this was true for both PCV and SGV + D. An increased recurrence rate was, on the other hand, found to be associated with < 50% postoperative reduction in pentagastrin-stimulated acid secretion.

Recovery of Gastric Acid after Vagotomy with and without a Drainage

“…As reported previously by Andersen et al [2], the reduction in PAO was 15% greater after SGV + D and PCV + D as compared to PCV. It seems reasonable to assume that this apparent larger reduction is mainly a conse quence of a sampling error due to the drainage procedure.…”

“…In the Aarhus County Vagotomy Trial [1], pentagastrin tests were per formed preoperatively, and 3 months and 1 year after surgery. In part II of this report [2] the acid reduction was shown to be significantly greater after selective gastric vagotomy (SGV + D) and parietal cell vagotomy with a drainage (PCV + D) as compared to the reduction after PCV without drain age.…”

Twenty Years After Parietal Cell Vagotomy or Selective Vagotomy Antrectomy for Treatment of Duodenal Ulcer Final Report

“…This is similar to our previous report. 4 Patients were evaluated according to the Visick grading scale at each visit. In this report, the poorest score a patient received during the observation periods ofa time frame was the score used for evaluating the patient's clinical results for that time frame.…”

Clinical Significance of M₁ Receptor Antagonists

“…This treatment leads to healing of the acute ulcer. It prevents relapse with a considerable degree of certainty (15% cumu lative relapse rate during 5 years of follow-up in centres with well-trained surgeons [16]. It must be assumed that this effect is the prod uct of the moderate reduction of basal and stimulated acid output which follows the se lective denervation of the parietal cell mass.…”