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

Abstract

ObjectiveThis study was a prospective, randomized evaluation of parietal cell vagotomy (PCV) and selective vagotomy-antrectomy (SV-A) in the treatment of duodenal ulcer.Background Data

An improved technique for laparoscopic highly selective vagotomy using harmonic shears

“…The results of the acid secretion studies in our series showing a reduction of 79.2% in pentagastrin-stimulated MAO at 2 months compare favorably with the results obtained after open HSV, ranging from 59% [12] to 70% in Johnston and Wilkinsen's original article [10]. This confirms that the use of a new HSV technique did not adversely affect the outcome and achieved adequate vagal denervation.…”

“…A recurrence rate of 16.5% at 25-year follow-up has been reported [12]. Limited access techniques may offer the patient not only a shorter and more comfortable postoperative course, but possibly fewer long-term complications associated with laparotomy such as adhesion formation.…”

“…The object of the procedure is to divide all vagal nerve fibers innervating the acid-producing cells of the stomach while preserving the terminal branches of the main vagal trunks and the nerves of Latarjet, thereby maintaining adequate antral motility. Numerous clinical studies have found this procedure to be both safe and effective when performed by experienced surgeons [6,11,12].…”

Peptic Ulcer Disease

“…Hp infection probably accounts for the large majority of other cases but data are limited and rates of Hp infection vary considerably among available studies [380,381]. Although perforation occurs in patients without an ulcer history, when a detailed history is taken after recovery, the majority of patients report having ulcer symptoms before the perforation [382]. Although perforation occurs in patients without an ulcer history, when a detailed history is taken after recovery, the majority of patients report having ulcer symptoms before the perforation [382].…”

Invited Commentary

“…2,3 Now, in the post-H pylori era, we are seeing patients with bleeding or partial gastric outlet following treatment with anti-H pylori antibiotics in addition to antisecretory medications. When this important topic was con¬ sidered prior to the current information about Helicobacter species (pre-H pylori era), the issues that required consideration would have been the chronicity of the ulcer process; the presence of anatomic deformities, such as severe pyloric stenosis, prepyloric or antral ulcers in conjunction with duodenal deformity, or extremely large size (giant gastric or duodenal ul¬ cers); or other associated comorbidities that affect the natural history of ulcer disease.…”