Long-term recurrence patterns following proximal gastric vagotomy

Area of Science:

• Gastroenterology
• Surgical Oncology
• Clinical Medicine

Background:

• Peptic ulcer disease remains a significant clinical challenge.
• Surgical interventions like proximal gastric vagotomy (PGV) have been employed for ulcer treatment.
• Long-term outcomes and recurrence patterns after PGV require continued investigation.

Purpose of the Study:

• To evaluate the long-term efficacy and safety of proximal gastric vagotomy (PGV) for ulcer treatment.
• To determine the recurrence rates and identify factors influencing outcomes after PGV.
• To assess the utility of Burge intra-operative testing in reducing recurrence rates.

Main Methods:

• Prospective follow-up of 242 consecutive patients undergoing elective PGV for duodenal, pyloric, or prepyloric ulcers.
• Assessment of operative mortality, complications, and ulcer recurrence rates over 5 to 15 years.
• Comparison of recurrence rates between patients operated with and without Burge intra-operative testing.

Main Results:

• No operative mortality or lesser curve necrosis observed.
• Overall recurrence rate of 11% (7% chronic/malevolent), with the majority occurring within 5 years.
• No significant difference in recurrence rates based on Burge intra-operative testing.
• Higher recurrence rates (43%) observed in patients with pyloric or prepyloric ulcers.

Conclusions:

• PGV is a safe surgical treatment for duodenal ulcers with acceptable recurrence rates and low complication incidence.
• The majority of PGV recurrences manifest early in the follow-up period.
• PGV is not recommended for pyloric or prepyloric ulceration due to increased recurrence risk.