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Bleeding duodenal ulceration: the results of emergency treatment with highly selective vagotomy
R Brancatisano1, G L Falk, J W Hollinshead
1Department of Surgery, Concord Hospital, New South Wales, Australia.
Insights
Highly selective vagotomy (HSV) effectively treats bleeding duodenal ulceration (BDU) with good long-term outcomes. This surgical approach demonstrated a high success rate in emergency BDU treatment with minimal lasting side effects.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
- Clinical Surgery
Background:
- Bleeding duodenal ulceration (BDU) presents a significant clinical challenge.
- Emergency surgical intervention is sometimes required for BDU management.
Purpose of the Study:
- To evaluate the efficacy and safety of highly selective vagotomy (HSV) in the emergency treatment of bleeding duodenal ulceration (BDU).
- To assess the long-term outcomes and sequelae of HSV for BDU.
Main Methods:
- Prospective study of 63 patients undergoing HSV for BDU between 1979 and 1989.
- Follow-up of 55 patients, with a mean review period of 50 months.
- Evaluation of postoperative mortality, morbidity, rebleeding rates, ulcer recurrence, and symptom grading (Visick I/II).
Main Results:
- Thirty-day postoperative mortality was 11% (7 patients).
- Combined major and minor morbidity was 41%.
- Postoperative rebleeding occurred in 6.3% of patients, with a 4% recurrence rate of ulceration.
- 93% of evaluated patients reported excellent or good outcomes (Visick I/II).
Conclusions:
- Highly selective vagotomy (HSV) is an effective emergency treatment for bleeding duodenal ulceration (BDU).
- HSV is associated with few long-term sequelae, offering a favorable risk-benefit profile for selected patients.
Abstract:
We report the results of a prospective study of all patients undergoing highly selective vagotomy (HSV) for bleeding duodenal ulceration (BDU) at Concord Hospital between 1979 and 1989. Highly selective vagotomy was undertaken in 63 patients (58 male, 5 female) with a median age of 69 years (range: 16-89). Fifty-five patients were reviewed, 7 patients having died in the peri-operative period and one being lost to follow-up. The mean period to review was 50 months (range: 1-120). Thirty-six patients have been followed-up for more than 24 months. Thirty-day postoperative mortality was 11% (7 patients). Combined major and minor morbidity was 41%. Postoperative rebleeding occurred in four patients (6.3%), three of whom died. Ulceration had recurred in two of 55 patients (4%). Symptoms have been evaluated in 55 patients since operation and 93% have been graded as Visick I or II. We conclude that HSV is effective in the emergency treatment of BDU and has few long-term sequelae.