Proximal gastric vagotomy for peptic ulcer disease: follow-up of 483 patients for 3 to 14 years.

During the years 1972 to 1986, proximal gastric vagotomy was performed in 483 patients for management of duodenal, pyloric, or prepyloric ulcers. In 25 patients a drainage procedure was added because of pyloric stenosis. The operations were performed by 64 surgeons, most of whom were junior residents. After surgery four patients had lesser curve necrosis; one of the patients died. The 14-year cumulative ulcer recurrence rate was similar (about 13%) in patients treated for duodenal and pyloric/prepyloric ulcers. The cumulative recurrence rate was significantly higher in women (17%) than in men (12%). Twenty-three percent of female patients and 16% of male patients were considered Visick grade 4. Moderate dumping occurred in 29% and diarrhea in 7% of the patients. The diarrhea was moderate except in one patient who had disabling diarrhea. Women had more frequent nausea, epigastric fullness after meals, and food intolerance than men. Basal acid output, pentagastrin-stimulated peak acid output, and insulin-stimulated peak acid output were not found to be reliable tests for evaluating the completeness of vagotomy or predicting ulcer recurrence.