Vagotomy Plus Bilroth H Gastreciomy for the Prevention of Recurrent Alcohol-induced Pancreatitis

Abstract

Three retrospective reviews documenting a lessened frequency of acute recurrent alcohol-induced pancreatitis following vagotomy, with or without gastrectomy or gastroenterostomy, prompted a prospective evaluation of truncal vagotomy with Bilroth II gastrectomy as a means of preventing such exacerbations. Randomization between operation and encouragement to abstain from alcohol in patients with a history of more than 1, but less than 10 acute bouts of alcohol-induced pancreatitis was set by odd-even digits in the hospital number. Of 176 patients admitted with acute alcoholic pancreatitis during 23 mo. of study, 49 were excluded because of too few or too many prior attacks. Another 61 refused to enter the study. At least 1 (average 1.9) recurrence requiring hospitalization was noted in 49, or 80% of these patients on follow-up for 2-26 mo. (average 14 mo.). Of the 66 who consented to participate, 33 were randomized not to undergo operation and had almost identical recurrence statistics (i.e., an average of 1.7 recurrences in 24, or 73%). By contrast, only 2 of 31, or 6%, allocated to operation experienced a recurrence (P < 0.001). Two who had been randomized were excluded because of persisting active pancreatitis.