Proximal gastric vagotomy. Follow-up of 109 patients for 6-13 years

From January 1973 through December 1979, 131 patients underwent proximal gastric vagotomy (PGV) for duodenal ulcer. There were 78 men and 53 women, whose age ranged from 19 to 73 years, with a mean age of 45 years. One hospital death occurred as a result of pulmonary embolism (0.7% mortality). There were 12 late deaths unrelated to ulcer disease, and each of the 12 patients was graded Visick I or II prior to death. Nine patients were lost to follow-up. This report is an analysis of the remaining 109 patients followed from 6 to 13 years. One hundred two patients (93.5%) underwent PGV for intractability. Seven patients (6.5%) who underwent PGV in selective circumstances for either acute perforation (3 patients), bleeding (1 patient), and moderate outlet obstruction (3 patients) are included. Follow-up results reveal that 52 patients (47%) are graded Visick I, 40 patients (36%) Visick II, five patients (5%) Visick III, and 12 patients (12%) Visick IV. Mild diarrhea occurred in 2.8% and mild dumping in 1.9%, and no reflux gastritis or esophagitis was noted. Recurrent ulceration took place in 10 patients, and seven subsequently required reoperation. Two additional patients had the antral pump mechanism denervated and later required antrectomy. PGV has yielded satisfactory results over a 6-13 year follow-up when operation was done for intractability. The low incidence of unpleasant long-term side effects is an appealing feature of the operation. A recurrent ulcer rate of 9.2% (10 patients) has, however, been of major concern. Those with a prime interest in gastric surgery are urged to continue the use of PGV in cases of intractability. Another 10 years of clinical investigative work will no doubt be necessary to determine the ultimate rate of recurrent ulceration.