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Postvagotomy diarrhoea put into perspective.

S A Raimes, V Smirniotis, E J Wheldon

    Lancet (London, England)
    |October 11, 1986
    PubMed
    Summary
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    Truncal vagotomy and pyloroplasty (TVP) surgery for duodenal ulcers frequently causes long-term diarrhea. Compared to cimetidine treatment, TVP patients experienced significantly more frequent and severe bowel issues, impacting quality of life.

    Area of Science:

    • Gastroenterology
    • Surgical Outcomes
    • Pharmacological Treatments

    Background:

    • Truncal vagotomy and drainage remains a common duodenal ulcer operation in the UK.
    • This surgical approach is associated with a known risk of post-operative diarrhea.
    • Alternative long-term medical management for duodenal ulcers exists.

    Purpose of the Study:

    • To compare the frequency and severity of diarrhea after truncal vagotomy and pyloroplasty (TVP) versus long-term cimetidine treatment.
    • To assess the long-term impact of TVP on bowel function and patient satisfaction.
    • To evaluate the clinical significance of diarrhea as a side-effect of TVP.

    Main Methods:

    • A comparative study involving 102 men who underwent TVP and 62 men receiving long-term cimetidine for healed duodenal ulcers.

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  • Participants were assessed 10 or more years post-TVP and 2 or more years post-cimetidine treatment.
  • Diarrhea frequency, severity, and patient-reported outcomes regarding bowel function were recorded.

    • Main Results:

    • 53% of TVP patients reported diarrhea attacks compared to only 7% in the cimetidine group (p < 0.001).
    • Among TVP patients, 11% experienced continuous diarrhea, and 22% had at least weekly attacks.
    • 24% of TVP patients were displeased with altered bowel function, with 8% reporting significant life impact.

    Conclusions:

    • Diarrhea is a frequent and significant long-term side-effect of truncal vagotomy and pyloroplasty for duodenal ulcers.
    • The incidence and severity of diarrhea in TVP patients far exceed those managed with long-term cimetidine.
    • Truncal vagotomy should be reconsidered and avoided due to its unacceptable impact on bowel function.