[Results of selective proximal vagotomy after 13 years]

Long-term clinical results of highly selective vagotomy performed between 1980 and 1990

A retrospective analysis was conducted of 778 patients who underwent highly selective vagotomy between 1980 and 1990. Surgery was performed for duodenal ulcers without any complications in 485 (62.3%) patients; for duodenal ulcers with complications such as stenosis, bleeding, or perforation in 270 (34.7%); for combined duodenal and ventricular ulcers in 12 (1.5%), and for ventricular ulcers alone in 11 (1.4%). Pyloroplasty was additionally performed in the presence of complications only. The incidence of intraoperative complications proved to be as high as 1.4%, occurring in 11 patients, while postoperative complications developed in 247 patients (31.7%). Although the overall mortality was 0.6% (5 patients), the mortality rate of those patients who underwent surgery for uncomplicated ulcer disease was 0.2% only (2 patients). The patients comprised 554 men (71.2%) and 224 women (28.8%) with an average age of 41.4 +/- 0.7 years. The average duration of duodenal ulcer disease was 9.5 years, and 643 (83.2%) of the patients were able to be regularly followed up for between 3 and 13 years. Recurrence developed in 62 patients (9.6%): in the duodenum in 57 patients (91.9%), and in the stomach in 5 (8.1%). The rate of recurrence according to sex was 9.4% in men and 10.3% in women, being 42 and 20 patients, respectively. The average duration until recurrence appeared was 27.06 +/- 3.44 months. A reoperation proved necessary in 28 of these 62 patients (45.1%). The clinical results were evaluated by means of a modified Visick classification, according to which 81.8% of the patients belonged to groups 1 or 2, 7.9% to group 3, and 10.3% to group 4.

[Billroth I hemigastrectomy in complicated recurrent ulcer after selective proximal vagotomy]

The outcome of Billroth I hemigastrectomy for complicated recurrent ulcers after proximal selective vagotomy (PSV) for duodenal ulcer was analyzed in a retrospective study of 15 patients followed up for 15-81 months (mean 3.8 years) postoperatively. Bleeding was reported in 4, stenosis in 5, penetration in 3, perforation in 1 and refractory ulcer in 2 cases. None of the patients died during revision surgery, and none developed ulcer recurrence. In 4 patients complications were seen, including bleeding requiring relaparotomy (1) and subhepatic hematoma (3). In 12 patients (80%) a good or excellent result (Visick I/II) was seen at follow-up. Reasons for Visick III or Visick IV classification were reflux esophagitis grades I and II in 2 cases and refractory dyspeptic symptoms in 1 case. Distal gastric resection with a Billroth I anastomosis for complicated recurrent ulcer after PSV proved to involve only low morbidity and to effect reliable prophylaxis of ulcer recurrence in the long term.