Parietal cell vagotomy for duodenal and pyloric ulcer: clinical and secretory results.

In the Department of Surgery, University of Turku, 310 patients underwent parietal cell vagotomy for duodenal (268 patients) or pyloric-prepyloric ulcer (42 patients) in the years 1973-82. The male/female ratio was 4/1 and mean age 43 years. There was no mortality. Splenic injury led to splenectomy in 2.6%. A relaparotomy for intraabdominal bleeding was done in 1%. No case of minor curve necrosis occurred. During the follow-up of 3-9 (mean 5) years 9 patients had died of unrelated causes and 29 could not be traced leaving 272 patients for study. Late symptoms occurred as follows: Dyspepsia 20% (recurrences excluded), heartburn 17%, regurgitation 8%, vomiting 4%, epigastric fullness 12%, dumping 5% and diarrhoea 6%. There were 17 proven recurrences of ulcer (6.3%), 11 after original duodenal ulcer (4.7%) and 6 after pyloric-prepyloric ulcer (16.7%). In addition, 4 patients were reoperated for other reasons (1 for dyspepsia, 1 for stenosis and 2 for oesophagitis). The overall results according to the Visick classification were as follows: Grade I 49%, grade II 18%, grade III 15%, grade IV 18%.

CONCLUSIONS

the method is safe and when used for duodenal ulcer will give satisfactory results, but after pyloric or prepyloric ulcer the recurrence rate may be higher.