Prospective Controlled Vagotomy Trial for Duodenal Ulcer

Abstract

In a prospective, controlled clinical trial, vagotomies for duodenal, pyloric and prepyloric ulcers were performed on 259 patients. Eighty-three patients were randomly selected for truncal vagotomy and drainage (TV + D), 93 patients were randomly selected for selective gastric vagotomy and drainage (SV + D) and 83 patients were randomly selected for parietal cell vagotomy without drainage (PCV). This interim report deals with the primary results, reduction in acid secretion, sequelae and recurrence rates 2-5 yr after the operation. One patient died after the operation. Postoperative complications were evenly distributed between the 3 operations. No differences in spontaneous acid secretion (BAO), peak acid output after pentagastrin stimulation (PAOP), or peak acid output after insulin stimulation (PAOI) were found. Patients with recurrent ulcers had smaller reductions in BAO than patients without ulcer recurrences, although not significantly. Patients with ulcer recurrences after TV + D had, in contrast to ulcer recurrences after SV + D and PCV, a significantly smaller reduction in PAOP than patients without recurrences. The overall recurrence rate was 13%: 10% after TV + D, 14% after SV + D and 16% after PCV. The risk of ulcer recurrence within the first 3 yr, calculated by an actuarial method, was significantly higher after PCV (0.52%/mo.) than after TV + D (0.32%/mo.), but not different from SV + D (0.42%/mo.). In contrast to TV + D and SV + D, no recurrences after PCV occurred after 3 yr-25% of the patients were followed for 5 yr. The trial, at present, apparently does not point to any evident superiority of PCV.