Evaluation of an intraoperative test for the completeness of vagotomy

An intraoperative test for the completeness of vagotomy has been evaluated in 103 consecutive operations, including proximal gastric, selective and truncal vagotomies, and truncal vagotomy with antrectomy. At the completion of the vagotomy a pH probe was used to test gastric mucosal response to an intravenous infusion of pentagastrin, aiming to detect undivided vagal fibres by localizing residual areas of acid secretion. Testing was performed in 86 out of 103 vagotomies, and in only 34% was the vagotomy judged complete at the first attempt. Residual areas of acid secretion (usually small) were detected in the remainder, and in early all of these it was possible to abolish these areas by dividing further vagal fibres. It is suggested that intraoperative pH testing improves the likelihood of a complete vagotomy. The test is also useful to plot precisely the antral-body junction when antrectomy is combined with vagotomy.