Proximal gastric vagotomy and mucosal antrectomy: a comparative physiologic examination

Area of Science:

• Gastroenterology
• Surgical Research
• Physiology

Background:

• The cephalic and hormonal phases of acid secretion are key targets for managing acid-related disorders.
• Proximal gastric vagotomy (PGV) aims to reduce acid secretion by targeting the vagal nerve supply to the stomach.
• Mucosal antrectomy (MA) involves removing the antral portion of the stomach, which is rich in gastrin-producing cells.

Purpose of the Study:

• To evaluate the effects of PGV and PGV-MA on gastric acid secretion, gastrin levels, and gastric emptying.
• To compare the efficacy of PGV-MA with PGV in modulating these parameters.
• To assess the potential of PGV-MA as a surgical alternative for duodenal ulcer disease.

Main Methods:

• Twelve dogs were used to measure gastric emptying, fasting and postcibal acid production, and fasting and postprandial gastrin levels.
• Animals underwent either PGV or PGV-MA, with subsequent repetition of all measurements.
• Statistical analysis was performed to compare the effects of the procedures against control and each other.

Main Results:

• PGV significantly decreased basal acid secretion but allowed a substantial postprandial acid increase.
• PGV-MA nearly abolished both fasting and postprandial acid secretion, showing significant differences from control and PGV.
• Neither PGV nor PGV-MA significantly altered gastric emptying. PGV-MA resulted in lower gastrin levels compared to controls and PGV.

Conclusions:

• PGV-MA effectively suppresses gastric acid secretion and lowers gastrin levels without compromising gastric emptying.
• The effects of PGV-MA on acid secretion mimic those of truncal vagotomy and antrectomy.
• PGV-MA represents a promising surgical option for duodenal ulcer disease treatment that warrants further investigation.