A comparison of highly selective vagotomy with truncal vagotomy and pyloroplasty—one surgeon's results after 5 years

Abstract

In a prospective randomized trial highly selective vagotomy (HSV) was compared with truncal vagotomy and pyloroplasty (TVP). One surgeon performed all the operations. Ninety-eight per cent of patients were reviewed by two physicians after 20–97 mth (mean 61 mth). Fifty-nine of 68 patients (87 per cent) had an excellent or very good result after HSV (Visick grades I and II) compared with 48 of 69 (70 per cent) after TVP (P < 0·05). There was 1 proven recurrence after HSV and 4 after TVP. Diarrhoea, including mild symptoms, occurred in 5 patients (7 per cent) after HSV and in 27 (39 per cent) after TVP (P < 0·001). Severe diarrhoea did not occur after HSV but was present in 4 patients (6 per cent) after TVP (P < 0·001). Flatulence, epigastric fullness and weight loss were also significantly more common after TVP. On average HSV took 72 min to perform compared with 44 min for TVP (P < 0·001). Transient dysphagia occurred in 19 patients after HSV compared with 8 after TVP (P < 0·05). HSV gave better results than TVP and was associated with a low recurrence rate (1·5 per cent at a mean of 5 yr). Although technically more demanding, HSV in our hands is a better operation than TVP for uncomplicated duodenal ulcer.