[The place of selective proximal vagotomy in complicated duodenal ulcers]

From 1980 to 1988 417 patients underwent surgery for peptic duodenal ulcer. Complications were present in 217 patients: perforation (40%), bleeding (32%), stenosis (20%) or penetration (8%). Highly selective vagotomy was performed in 67% of all patients. The number of operations for duodenal ulcer decreased (1984 n = 61, 1988 n = 28) due to fewer operations for uncomplicated ulcers, whereas the number of operations for complicated cases remained equal. Mortality after highly selective vagotomy for complicated duodenal ulcer was 5.2%. All fatalities occurred after bleeding. Whereas highly selective vagotomy was performed frequently for stenosing (72%) and bleeding (68%) ulcers it was the exception in perforate duodenal ulcers (13%). A tendency to increased performance of highly selective vagotomy in complicated cases is evident (1981 40%, 1988 70%). A further increase seems possible by using more liberal indications for selective vagotomy in perforated ulcers and by more frequently carrying out preoperative endoscopic hemostasis in bleeding duodenal ulcers.