Pyloric reconstruction for severe vasomotor dumping after vagotomy and pyloroplasty

The performance of vagotomy and pyloroplasty is followed by the occurrence of dumping symptoms in 10-30% of patients. In a few, these are severe, persistent, and refractory to dietary and medical management. Pyloric reconstruction was performed in nine patients with severe dumping symptoms. All patients were treated conservatively for at least 1 year before reconstruction. Gastric emptying studies, using a 99mTc-sulphur colloid labeled 15% dextrose, were performed before and after reconstruction in each case. All were Visik grade IV before surgery. After pyloric reconstruction, interviews were conducted by a separate clinician not involved in any management of the patients. Overall improvement was obtained in eight of nine patients. Four patients improved to Visik grade II, and four to Visik grade III. With regard to dumping symptoms only, seven of nine were improved to Visik grade II. All patients had double exponential gastric emptying curves before surgery, and six of the nine reverted to single exponential curves similar to those of unoperated controls. The initial 10-minute emptying rate was significantly decreased (p less than 0.05), and the per cent retention at 60 minutes (p less than 0.02) was significantly increased. Improvement in gastric emptying correlated well with relief of symptoms. Pyloric reconstruction is relatively simple and corrects rapid gastric emptying at the gastric outlet. These results indicate that pyloric reconstruction significantly benefits most patients with severe dumping symptoms and should be considered as the initial remedial procedure for dumping after pyloroplasty.