Treatment of gastric ulcer by highly selective vagotomy without a drainage procedure: An interim report

Abstract

Fourteen patients with gastric ulcer alone and 5 patients with combined gastric and duodenal ulceration- have been treated by highly selective (parietal-cell) vagotomy without a drainage procedure (H.S.V.) the past 3 years. Before operation no evidence of gastric stasis was found, clinically, radiologically, or during tests of gastric secretion. Spontaneous acid out was low. Acid output in response to a test meal of meat extract was also found to be low. There no evidence that in the patients with gastric ulcer alone the ulcer was due to pyloric channel disease with excessive release of gastrin by the antrum. Each gastric ulcer was proved by frozen-section examination to be benign at the time of operation. Problems with gastric stasis were encontered in early postoperative period. The vagotomy was shown to be complete on insulin testing in each of 17 patients tested. Follow-up ranges from 1 month to 3 years. The clinical progress of the patients has been good, and has symptoms suggestive of recurrent ulceration gastric retention. Barium-meal examination in 11 patients who were follwed up for more than 9 months showed satisfactory gastric emptying, without recurrent ulceration. While the need for much longer follow-up is obvious, these preliminary results are encouraging. Further trial of H.S.V. for gastric ulcer, preferably in the form of a prospective, randomized comparison with Billroth-I gastrectomy, now seems desirable.