Remaining indications for vagotomy with drainage or antrectomy in duodenal ulcer

Proximal gastric vagotomy (PGV) consists of denervation of the body and fundus of the stomach, the antral nerve supply being left intact. It has a low operative morbidity and mortality and there are few postvagotomy side effects. However, the recurrent ulcer rate may be higher than with other operations for duodenal ulcer. Nevertheless it is usually easier to treat post-PGV recurrence than the complications of other gastric acid lowering operations. This study defines those patients in whom we have not performed a PGV. Of 110 operations for duodenal ulcer since 1980, 70 were PGVs while 40 consisted of truncal or selective vagotomy combined either with a drainage procedure or antrectomy. It is our practice not to perform a PGV in those patients with prepyloric ulcers, pyloric stenosis, bleeding or perforated ulcers and recurrent ulcers.