[Postoperative syndromes and recurrence in highly selective vagotomy]

In a prospective multicenter trial the clinical results and recurrences after proximal gastric vagotomy (PGV) in different gastroduodenal ulcer types have been investigated. Pyloric and prepyloric ulcers showed a significantly higher recurrence rate after PGV without drainage than duodenal and gastric ulcers. The secretory pattern could not explain the failure of PGV in these two ulcer types, which exhibit an alteration of the muscular layer at the pylorus and the distal antrum, a so called antropyloric dystrophy. About 60% of the recurrent ulcers after PGV stay asymptomatically. A refined concept for surgical treatment of peptic ulcer is proposed.